Survival of patients with disseminated midgut carcinoid tumors after aggressive tumor reduction.

• Sixty-four consecutive patients with disseminated midgut carcinoids were treated during an 8-year period according to a single clinical protocol aimed at aggressive tumor reduction by surgery alone or with subsequent hepatic artery embolization. All patients had markedly elevated urinary 5-hydroxyindoleacetic acid (5-HIAA) levels (581 +/- 79 micromol/24 h) and hormonal symptoms. Fourteen patients (22%) reached anatomic and biochemical cure by surgery alone. At follow-up, the mean 5-HIAA levels were still normal after 69.0 +/- 6. 2 months; two patients had died from unrelated causes. With the introduction of somatostatin receptor scintigraphy, subclinical disease was diagnosed in 7 of these 14 patients. Forty patients with bilobar hepatic disease underwent embolization in combination with octreotide. In this group, 5-HIAA levels were still reduced by 55% after 71 +/- 11 months of follow-up, and the 5-year survival was 56%, estimated from the total death hazard function. After embolization, two subgroups could be identified with marked differences in their long-term response to treatment. Ten patients were not embolized owing to complicating diseases. The 5-year survival for the entire series was 58%. A significantly increased risk of cardiovascular deaths was seen, which underlines the importance of total survival analysis in a disease with multiple hormonal effects. It is concluded that an active surgical approach must be recommended to patients with the midgut carcinoid syndrome. In patients with bilobar hepatic disease, embolization combined with octreotide treatment markedly reduced the 5-HIAA excretion and suggested a prolonged 5-year survival.

Ämnesord

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Gastroenterologi (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Gastroenterology and Hepatology (hsv//eng)

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Endokrinologi och diabetes (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Endocrinology and Diabetes (hsv//eng)

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Cancer och onkologi (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Cancer and Oncology (hsv//eng)

Nyckelord

Adult

Aged

Antineoplastic Agents

Hormonal

therapeutic use

Carcinoid Tumor

pathology

secondary

surgery

urine

Cause of Death

Clinical Protocols

Combined Modality Therapy

Death

Sudden

Cardiac

Embolization

Therapeutic

Female

Follow-Up Studies

Hepatic Artery

Humans

Hydroxyindoleacetic Acid

urine

Indium Radioisotopes

diagnostic use

Intestinal Neoplasms

pathology

surgery

urine

Liver Neoplasms

secondary

therapy

Male

Middle Aged

Octreotide

analogs & derivatives

diagnostic use

therapeutic use

Pentetic Acid

analogs & derivatives

diagnostic use

Radiopharmaceuticals

diagnostic use

Receptors

Somatostatin

analysis

Remission Induction

Risk Factors

Survival Analysis

Survival Rate

Publikations- och innehållstyp

ref (ämneskategori)

art (ämneskategori)