Outcomes of liver-directed therapy for metastatic carcinoid tumors.

Abstract

356 Background: Patients with liver metastases from carcinoid tumors can have a variable and often indolent disease course. That said, left untreated, these tumors will often lead to the death of the patient secondary to the effects of tumor burden within the liver and the sequelae of carcinoid syndrome. In this study, we evaluate the effects of liver directed therapy on disease-specific survival in patients with liver metastases from carcinoid tumors. Methods: The California Cancer Registry was queried for patients with liver metastases from a primary carcinoid tumor. Demographic data was recorded. Patients were subdivided into six groups: those who received 1) no liver directed therapy, 2) surgical resection only, 3) trans-arterial chemoembolization (TACE) only, 4) radioembolization (RE) only, 5) surgical resection plus TACE, or 6) surgical resection plus RE. Kaplan-Meier curves were applied to estimate 10 year disease-specific survival. Results: 4,566 patients were identified with liver metastases from a primary carcinoid tumor, and 4,277 patients with complete clinical information included in the analysis. A slight majority of cases were male (51.4%), 183 (4%) were less than 40 years of age, 2,006 (44%) were between 40 and 65 years, and 2,363 (52%) were over 65. The 10 year median disease-specific survival was 66 months for those treated with TACE only, 80 months for those who received no liver directed therapy and 111 months for those who received liver resection plus TACE. The 10 year median survival has not yet been reached for the other groups. When compared directly, surgery plus RE had a trend toward better disease specific survival than surgery plus TACE, though statistical significance was not reached. Conclusions: While patients with liver metastases from carcinoid tumors often have an indolent disease course, liver directed therapy may help improve disease-specific survival. Surgical treatment, when completely resectable, remains the best treatment, although many patients will not have disease that is amenable to complete resection. In these cases, resection with the addition of RE appears to be more effective in improving disease-specific survival than other forms of liver directed therapy alone or in combination.