Abstracts
2000 Digestive Disease Week

# 2278 Lipiodol/Gelfoam Chemoembolization for Control of Carcinoid Syndrome Symptoms and Octreotide Requirements.
Frank J. Wessels, Scott R. Schell, Lisa E. Moffat, James G. Caridi, Irvin F. Hawkins, Edward M. Copeland, Gainesville, FL

Background: Hepatic artery chemoembolization has shown promise for treating symptoms and slowing tumor progression for patients with advanced hepatic metastases from carcinoid tumors. Prior studies examined single or continuous hepatic artery infusions using ethiodized oil with or without other agents, and several have shown improvement in short-term quality of life and tumor progression. Our institution uses a technique of repeated selective transcatheter hepatic artery embolization using Lipiodol and Gelfoam for treatment of various primary and metastatic hepatic tumors. This report reviews our experience in fifteen patients with advanced, unresectable hepatic metastases from carcinoid tumors, examining symptom control, quality of life, dependence upon octreotide, and tumor progression. Methods: Fifteen (6 male, 9 female, mean age 61.1±5.4 yr.) patients with unresectable bilobar hepatic metastases from carcinoid tumors were treated with selective hepatic artery embolization using Lipiodol/ Gelfoam from 1994-1999. Patients had carcinoid diagnoses confirmed with urinary 5-HIAA levels, and biopsy-proven neuroendocrine tumors. Before treatment, 10 patients (67%) had carcinoid syndrome. Median follow-up was 29.3 mos. We developed an analog scale for rating symptom severity, ranging from a score of 1 for NO SYMPTOMS to a score of 5 for symptoms that were TOTALLY DISABLING or REQUIRED HOSPITALIZATION. Nine patients required octreotide for carcinoid symptom control prior to treatment. After treatment, symptom severity, octreotide dose, and tumor response were measured. Results: Patients without carcinoid syndrome did not develop symptoms or require octreotide during treatment. After treatment, Lipiodol uptake was seen on CT scan in all patients. Hepatic metastases were stable or decreased in size in 12 patients (80%). Patients with carcinoid syndrome demonstrated symptomatic relief and required less octreotide after treatment. Mean pre-treatment symptom scores were 3.9± 0.2, decreasing to 1.6± 0.3 after treatment, with 60% of patients asymptomatic. Mean pre-treatment octreotide dosages were 472±89 mcg/d, decreasing to 106±54 mcg/d after treatment, with 56% of patients off octreotide. One patient died from rapidly progressive extrahepatic disease. Conclusions: This study demonstrates that Lipiodol/Gelfoam hepatic artery chemoembolization produces excellent control of carcinoid syndrome, allowing patients to decrease or eliminate use of octreotide.