Chemoembolization of hepatic metastases from intestinal neuroendocrine tumours

Gastrointestinal neuroendocrine tumours, i.e. carcinoids and islet cell tumours, often metastasize diffusely into the liver, rendering complete surgical resection impossible. Unlike other malignancies, prolonged survival may occur even in advanced disease. Chemotherapy of these rare tumours is not only aimed at size reduction (objective response) but also at symptom reduction (biological response). Systemic therapy, using 5-fluorouracil, doxorubicin, cisplatin, cyclophosphamide, somatostatin-analogue, interferon or streptozotocin yielded response rates of up to 69%. Since neuroendocrine tumours are generally hypervascular locoregional chemotherapy and chemoembolization also have been used successfully. However, even though severe complications are rare, some degree of pain and the post-embolization syndrome are almost inevitably present. The expected therapeutic efficacy must be weighed against possible side effects. The best result that can be hoped for in the chemoembolization of intestinal neuroendocrine metastatic disease is, as yet, only palliation.