Hepatic arterial chemoembolization in the management of advanced digestive endocrine tumours

Liver metastases, in patients with gastroenteropancreatic endocrine tumours, are present in 25-90%, depending on the nature of the primary tumour. Surgical resection is indicated only for localised liver metastasis, whereas in most cases with diffuse liver involvement other therapeutic modalities such as intravenous chemotherapy, embolization or hepatic arterial chemoembolization, ligation or intra-arterial chemotherapy are currently available. Hepatic arterial chemoembolization is specifically indicated for progressive tumours (mainly carcinoids) confined to the liver especially after unsuccessful systemic chemotherapy. A mixture of cytotoxic drug and iodised oil followed by gelatine sponge particles are injected in the branches of the hepatic artery supplying the tumours. 66-100% positive results of this treatment have been reported in the carcinoid syndrome with a 50-91% decrease in 5-HIAA secretion. Variation of tumour size (WHO criteria) has been reported in 33-80% of the cases, even if no direct comparison between chemoembolization and other therapeutic modalities are currently available. Extensive follow-up of the treated patients and additional studies will clarify the role of chemoembolisation in advanced digestive neuroendocrine tumours.