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Repeat Hepatic Artery Chemoembolization for Patients with Progressive Hepatic Neuroendocrine Metastases Is Safe and Offers Similar Results to the First Hace
Kimberly a. Varker*1, Dori Klemanski1, Daniel Watkins1, Edward W. Martin1, Manisha H. Shah2, Mark Bloomston1
1Division of Surgical Oncology, The Ohio State University, Columbus, OH; 2Division of Hematology/Oncology, The Ohio State University, Columbus, OH

Background: Hepatic artery chemoemobolization (HACE) is commonly applied in patients with metastatic carcinoid tumors. The management of patients who develop progressive disease is less clear. We sought to determine if patients with disease progression after HACE would derive benefit from repeat HACE.
Methods: The records of 27 patients undergoing repeat HACE for radiologic or symptomatic progression after HACE for metastatic carcinoid tumors were reviewed and compared to 122 undergoing first HACE. Overall and progression-free survival were estimated by the Kaplan-Meier method and compared by log-rank analysis.
Results: 27 patients (13 male, 14 female; median age 53) underwent repeat HACE at a mean disease-free interval of 11.8 months after the original HACE procedure. Radiologic response was observed in 61% compared to 82% after first HACE (p = 0.058); hormone response was seen in 64% compared to 80% after first HACE (p= 0.159); and symptomatic response was observed in 77% compared to 92% after first HACE (p = 0.053). The complication rate after repeat HACE was significantly less than after first HACE (p = 0.03). There was no mortality from repeat HACE, as compared to mortlity of 5% at first HACE. Overall median survival after repeat HACE (28.1 months) was similar to that after first HACE (33.3 months) (p = 0.53, figure). Progression-free survival was shorter after repeat HACE but not significant. No factor including age; comorbidity; site of primary; resection of primary; symptoms of carcinoid syndrome; or radiologic, hormone, or symptomatic response to the first HACE could predict survival after repeat HACE.
Conclusion: In patients with radiologic or symptomatic evidence of progression following HACE for metastatic carcinoid, repeat chemoembolization is safe and offers responses similar to those expected from the first HACE.

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