Carcinoid Disease Research Articles

Hypoxia stimulates CXCR4 signalling in ileal carcinoids

Tumour hypoxia is associated with increased metastatic potential and resistance to radiotherapy and chemotherapy. Ileal carcinoids are usually metastatic at the time of diagnosis and respond poorly to chemotherapy. The aim of this study was to investigate the extent of hypoxia in ileal carcinoids and the response of tumour cells to induced hypoxia. Vascular endothelial growth factor (VEGF), carbonic anhydrase (CA-IX), hypoxia-inducible factor (HIF)-1alpha and HIF-2alpha were studied by immunohistochemistry in biopsies from 24 patients with ileal carcinoids. All hypoxic markers were shown to be highly expressed in localized areas of the tumours irrespective of tumour location or stage. However, HIF-2alpha expression was significantly higher in distant metastases compared to primary tumours in the same patient. Global gene expression profiling of GOT1 carcinoid cells revealed a marked response to hypoxia. Expression of genes related to epithelial-to-mesenchymal transition and development was altered including increased expression of the C-X-C chemokine receptor type 4 (CXCR4), an important regulator of invasive growth and metastasis formation. High expression of CXCR4 was confirmed by immunohistochemistry in tumour biopsies. Stimulation of GOT1 cells by the CXCR4 ligand, CXCL12 (stromal cell-derived factor 1 (SDF-1)), activated the mitogen-activated protein kinase (MAPK) p42/44 signalling pathway and increased tumour cell migration. We conclude that ileal carcinoids contain hypoxic areas expressing HIF-1alpha, HIF-2alpha and CXCR4. Signalling through the CXCL12-CXCR4 axis may contribute to the metastatic potential of ileal carcinoids. Targeting of HIFs and/or the CXCR4 signalling pathway may offer new therapeutic strategies for carcinoid tumour disease.

Stenting of the Superior Mesenteric Vein in Midgut Carcinoid Disease with Large Mesenteric Masses

Midgut carcinoid (MGC) tumors generally develop in the small intestine and in >50% of cases also present with lymph node metastases in the mesentery. The majority of these tumors are surgically resectable, but a fraction are inoperable and may cause obstruction of the superior mesenteric vein (SMV), often associated with stasis of the intestinal wall and severe symptoms. These symptoms include severe abdominal pain, attacks of diarrhea, and malnutrition. Seven patients with severe MGC including a large fibrotic inoperable mesenteric mass and severe symptoms were studied. After an obstructed SMV and signs of venous stasis in the small intestine were demonstrated, an expandable stent was inserted after puncturing an intrahepatic portal venous branch. The associated venography, patient symptoms, and radiological signs on computed tomography (CT) scans were evaluated. Four patients demonstrated resolution of their symptoms. In one patient who had intra-abdominal lymph leakage/chyloperitoneum, a complete normalization of the circulation followed and the intra-abdominal lymph leakage stalled. The venographies demonstrated normalization of the venous blood flow through the SMV, and CT scans demonstrated reduction in the thickness of the intestinal wall. In two cases there were no changes in the symptoms, and in one case a slight worsening of the symptoms ensued. In general, reductions of symptoms were associated with the degree of normalization of venous blood flow. We conclude that in selected patients with MGC stenting of the SMV may improve symptoms.

Defining Surgical Indications for Type I Gastric Carcinoid Tumor

Most gastric carcinoid tumors (GC) (type I) occur in association with achlorhydria, hypergastrinemia, atrophic gastritis and exhibit low-grade histopathology. The management of this indolent disease is controversial. The aim of this study was to evaluate endoscopic surveillance (ES) compare with surgical resection (SR) for type I GC. Between 1985 and 2007, 65 patients with type IGC were identified. Data analysis included: demographics, biochemical and endoscopic assessment, type of operation performed, and pathologic evaluation. The primary endpoints were disease-specific survival (DSS) in both groups and recurrence-free survival (RFS) in SR patients. Median follow-up was 30 months (range 1-176 months); most patients were female (83%) with median age of 58 years (range 29-91 years). Type I GC was diagnosed by evidence of hypergastrinemia and/or positive autoimmune antibodies with histopathologic confirmation. Patients underwent ES with polypectomy (n=46) or gastric resection (n=19). SR was performed with larger tumor size, increased depth of invasion, and solitary tumors. Although the 5-year RFS in SR patients was 75%, the DSS in both groups was 100%. However, concomitant adenocarcinoma was identified in 4/19 resected cases; 2/4 were detected on preoperative biopsies. All cases with coexisting gastric adenocarcinoma had larger carcinoid tumors and more advanced carcinoid disease. The DSS is excellent for type I GC patients treated with either ES or SR. SR should be considered with more advanced carcinoid disease given its association with an increased risk of adenocarcinoma. ES is appropriate to assess both the status of carcinoid disease and dysplasia or adenocarcinoma that can develop in association with type I GC.

Safety and Efficacy of Microwave Ablation of Hepatic Tumors: A Prospective Review of a 5-Year Experience

This study was designed to evaluate the safety, efficiency, effectiveness, and overall long-term outcome in patients treated with microwave thermal ablation of hepatic tumors. Microwave ablation technology represents the next generation in ablative techniques for the treatment of hepatic malignancies. Currently there have been no large reports of its use in the United States with appropriate long-term follow-up. An institutional review board-approved prospective phase II study of microwave ablation of hepatic malignancies from January 2004 to January 2009 was performed. All complications were recorded up to 90 days from operation and reported using an established five-point grading scale. One hundred patients underwent 270 ablations for hepatic malignancies. The most tumor types were as follows: metastatic colorectal cancer (50%), hepatocellular carcinoma (17%), metastatic carcinoid (11%), and other metastatic disease (22%). A majority of patents (53%) underwent combination hepatic resection and microwave ablation; 38% underwent ablation alone, 9% underwent ablation and additional organ resection, with 68% open procedures. Median tumor size was 3.0 (range, 0.6-6.0) cm, median number of tumors was 2 (range, 1-18), and median total ablation time was 13 (range, 5-45) min. Overall 90-day mortality was 0% and morbidity was 29%. One patient developed a hepatic abscess and no patients experienced bleeding complications. After a median follow-up of 36 months, 5 patients (5%) had incomplete ablation, 2 (2%) had local recurrence at the ablated site, and 37 (37%) developed intrahepatic recurrence at nonablated sites. Microwave ablation of hepatic tumors is a safe and effective method for treating unresectable hepatic tumors, with a low rate of local recurrence.

Inhibition of Phosphatidylinositol 3-Kinase/Akt Signaling Suppresses Tumor Cell Proliferation and Neuroendocrine Marker Expression in GI Carcinoid Tumors

Overactivation of PI3K/Akt signaling facilitates tumor proliferation in several cancers. We have shown that various signal transduction pathways promote tumorigenesis in carcinoid tumors, which exhibit endogenously high levels of active, phosphorylated Akt. Therefore, we hypothesized that inhibition of the PI3K/Akt pathway would suppress carcinoid tumor cell growth and neuroendocrine (NE) marker production. Human carcinoid BON cells were treated in vitro with LY294002, a PI3-kinase inhibitor, or transfected with Akt1 siRNA. Tumor cell proliferation was measured by MTT for 6 days. The effect of LY294002 or Akt1 siRNA treatment was assessed by Western analysis. We examined the levels of phosphorylated Akt, total Akt, Akt1, and the NE markers human achaete-scute homolog1 (ASCL1) and chromogranin A (CgA). Treatment of BON cells with LY294002 reduced tumor cell proliferation (76%) in a dose-dependent manner. Growth also decreased in Akt1 siRNA transfected cells (26%). Levels of active, phosphorylated Akt and the NE tumor markers, ASCL1 and CgA, were diminished with both LY294002 and Akt1 siRNA treatments proportional to the degree of Akt inhibition. Total Akt, Akt2, and Akt3 levels were unaffected by these experiments. These data indicate that PI3K/Akt signaling performs a critical role in human carcinoid tumor cell survival and NE hormone generation. Furthermore, the development of novel therapeutics targeting Akt1 or components of the PI3K/Akt pathway may enhance the management of carcinoid disease.

MG-132 Inhibits Carcinoid Growth and Alters the Neuroendocrine Phenotype

Carcinoid cancers are the most common neuroendocrine (NE) tumors, and limited treatment options exist. The inhibition of glycogen synthase kinase-3beta (GSK-3beta) has been shown to be a potential therapeutic target for the treatment of carcinoid disease. In this study, we investigate the ability of MG-132, a proteasome inhibitor, to inhibit carcinoid growth, the neuroendocrine phenotype, and its association with GSK-3beta. Human pulmonary (NCI-H727) and gastrointestinal (BON) carcinoid cells were treated with MG-132 (0-4microM). Cellular growth was measured by the 3-[4,5-dimethylthiazole-2-yl]-2,5 diphenyl tetrazolium bromide (MTT) assay. Levels of total and phosphorylated GSK-3beta and the NE markers chromogranin A (CgA), Achaete-Scute complex-like 1 (ASCL1), as well as the apoptotic markers poly (ADP-ribose), polymerase (PARP), and cleaved caspase-3 were determined by Western blot. Treating carcinoid cells with MG-132 resulted in growth inhibition, a dose-dependent inhibition of CgA and ASCL1, as well as an increase in the levels of cleaved PARP and cleaved caspase-3. Additionally, an increase in the level of phosphorylated GSK-3beta was observed. MG-132 inhibits cellular growth and the neuroendocrine phenotype. This proteasome inhibitor warrants further preclinical investigation as a possible therapeutic strategy for intractable carcinoid disease.

Right-Sided Valve Disease Deserves a Little More Respect

Historically, right-sided valvular disease has received less attention from clinicians and researchers than left-sided valve disease, in part because of a protracted latent asymptomatic period. Moreover, because tricuspid regurgitation (TR) is often due to left-sided valve disease and pulmonary regurgitation (PR) is often secondary to congenital cardiac disease, the underlying disorder rather than the valve lesion tends to dominate the clinical picture. It is increasingly recognized that right-sided valve disease is not benign and has a significant and independent impact on morbidity and mortality. Today, diagnostic techniques and appropriate management strategies for patients with right-sided valve disease are established and continually refined. In this era of increasing awareness and improved treatment options for patients with valve disease, it is important that clinicians consider the diagnosis of right-sided valve disease, understand its pathophysiology, choose appropriate confirmatory testing, and refer patients for timely intervention to prevent clinical deterioration with associated adverse consequences. This review examines the causes of right-sided valve disease and the latest diagnostic advances and treatment options for these often-neglected valve lesions. Patients with native right-sided valve disease are rarely affected by endocarditis, and indications for prophylaxis have recently changed.1 ### Tricuspid Regurgitation TR that is at least moderate in severity is most frequently “functional” in nature and by definition not related to primary tricuspid valve (TV) leaflet pathology but rather secondary to another disease process causing right ventricular (RV) dilatation, distortion of the subvalvular apparatus, tricuspid annular dilatation, or a combination of these. Furthermore, a moderate or greater degree of TR, regardless of primary origin, usually engenders additional TR as a result of the adverse hemodynamic consequence of RV volume overload. Causes of clinically significant TR are outlined in Table 1; 2 classic examples of primary tricuspid leaflet pathology are demonstrated in Figure 1. View this table: Table 1. Causes of TV …

Combining 6-fluoro-[ 18F] l-dihydroxyphenylalanine and [ 18F]fluoro-2-deoxy- d-glucose positron emission tomography for distinction of non-carcinoid malignancies in carcinoid patients

Aim Carcinoid patients frequently develop a second primary malignancy (SPM), which can deserve full treatment. Distinguishing a SPM from carcinoid lesions is therefore important. Differentiation can be achieved using the difference in uptake between different positron emission tomography (PET) tracers. Methods and results Between January 2005 and August 2008, 105 carcinoid patients were seen at the Department of Medical Oncology for treatment and follow-up. We identified 3 patients who presented with a new SPM in whom differentiation between carcinoid lesions and the SPM was guided by functional imaging of the catecholamine pathway with 6-fluoro-[ 18F] l-dihydroxyphenylalanine ( 18F-DOPA) PET and [ 18F]fluoro-2-deoxy- d-glucose ( 18F-FDG) PET as radiotracer for the glucose metabolism. All 3 patients had metastatic carcinoid disease and localised adenocarcinoma based on the PET-scans. For the adenocarcinoma they received curative treatment. Conclusion The difference in uptake between these PET techniques can be used for decision making when a primary or metastatic SPM is suspected.

Anaesthetic management of a pregnant woman with carcinoid disease

Carcinoid tumours are neuroendocrine in origin and release vasoactive substances. Carcinoid tumours may be associated with carcinoid syndrome in 2–5% of patients and result in haemodynamic instability, bronchospasm, volume and electrolyte imbalance, and hyperglycaemia. We present the anaesthetic management of a 29-year-old parturient with metastatic carcinoid tumour. Although our patient did not ultimately develop carcinoid syndrome during the peripartum period, it was important that we used a multidisciplinary team approach, with close monitoring of her antenatal progress, and planned epidural analgesia for labour and delivery.

Development and Characterization of a Novel In vivo Model of Carcinoid Syndrome

Carcinoid syndrome, characterized by flushing, diarrhea, and valvular heart disease, can occur following carcinoid tumor metastasis to the liver and systemic release of bioactive hormones into the systemic circulation. Treatment of this devastating disease is hampered by the lack of an in vivo model that recapitulates the clinical syndrome. Here, we have injected BON cells, a novel human carcinoid cell line established in our laboratory, into the spleens of athymic nude mice to establish liver metastases. The majority of mice injected intrasplenically with BON cells developed significant increases in plasma serotonin and urine 5-hydroxyindoleacetic acid, and several mice exhibited mesenteric fibrosis, diarrhea, and fibrotic cardiac valvular disease reminiscent of carcinoid syndrome by both echocardiographic and histopathologic evaluation. Mice pretreated with octreotide, a long-acting somatostatin analogue, or bevacizumab, a vascular endothelial growth factor inhibitor, developed fewer liver metastases and manifestations of carcinoid syndrome, including valvular heart disease. We have provided an important in vivo model to further delineate novel treatment modalities for carcinoid syndrome that will also be useful to elucidate the factors contributing to the sequelae of carcinoid disease (e.g., mesenteric fibrosis and valvular heart disease).

Rectal carcinoids are on the rise: early detection by screening endoscopy

Rectal carcinoids are on the rise; in the United States the age-adjusted incidence has increased by 800% -1000% in the last 35 years. The incidence of carcinoids of the stomach, pancreas, or small bowels has also multiplied. The reasons for these epidemiological changes are not yet understood. Both screening sigmoidoscopy and screening colonoscopy lead to a shift to smaller-sized (< or =13 mm) rectal carcinoids and earlier tumor stages at diagnosis. During the last 35 years the overall 5-year survival of patients with rectal carcinoid disease has increased by almost 20% (in the US). Thus, endoscopic screening of the colorectum is effective in the early diagnosis not only of colorectal adenomas and adenocarcinomas but also of carcinoids. Rectal carcinoids that are 10.0 mm or less and do not infiltrate the muscularis propria can be removed endoscopically. If histological angioinvasion or lymph node metastases are found, surgical lymph node dissection has to be considered. Before deciding on definitive therapy, rectal carcinoids should be staged by means of endoscopic ultrasonography, CT, or MRI and somatostatin receptor scintigraphy.

Cardiac carcinoid: tricuspid delayed hyperenhancement on cardiac 64-slice multidetector CT and magnetic resonance imaging

Carcinoid heart disease is a rare condition in adults. Its diagnosis can be easily missed in a patient presenting to a primary care setting. We revised the advantages of using coronary multidetector computed tomography (MDCT) and cardiac magnetic resonance imaging (MRI) in diagnosing this condition. We studied a 65-year-old patient with carcinoid heart disease and right heart failure using transthoracic Doppler-echocardiogram, cardiac MDCT and MRI. Cardiac echocardiogram revealed marked thickening and retraction of the tricuspid leaflets with dilated right atrium and ventricle. Cardiac MDCT and MRI demonstrated fixation and retraction of the tricuspid leaflets with delayed contrast hyperenhancement of the tricuspid annulus. This case demonstrates fascinating imaging findings of cardiac carcinoid disease and highlights the increasing utility of contrast-enhanced MRI and cardiac MDCT in the diagnosis of this interesting condition.

Tricuspid and Mitral Valve Carcinoid Disease in the Setting of a Patent Foramen Ovale

59-yr-old-woman with an 8-yr history of carci-noid syndrome with hepatic metastasis presentedwith progressive shortness of breath. Transesophagealechocardiographic examination (TEE) revealed severetricuspid regurgitation, tricuspid stenosis, mild mitralstenosis, moderate mitral regurgitation, and a patentforamen ovale (PFO). She was referred for a tricuspidand mitral valve replacement.Intraoperative TEE confirmed the preoperative diag-nosis of mild tricuspid stenosis with leaflet and chordalthickening, severe tricuspid regurgitation by extent ofcolor flow jet area and hepatic vein flow reversal bypulse wave Doppler, severe right atrial and ventricularenlargement Video Clip 1; please see video clips avail-able at www.anesthesia-analgesia.org), mild mitral ste-nosis, and moderate mitral regurgitation with mitralleaflet thickening and posterior leaflet restriction (Figs. 1and 2; Video Clip 1). Agitated saline contrast injectionconfirmed a PFO. Mild pulmonary regurgitation wasalso noted but the aortic valve was uninvolved. Both themitral and tricuspid valves were replaced with pericar-dial bioprosthetic valves, and the PFO was repaired(Video Clip 2). The excised tricuspid valve was diffuselythickened and fibrotic and the mitral valve leafletsappeared white and smooth, consistent with carcinoidvalvular heart disease. The patient’s hospital course wascomplicated by recurrent carcinoid crises occurringwithin the first postoperative day. Her subsequent hos-pital course was uneventful and she was discharged onpostoperative day 10.Carcinoid tumors arise from the gastrointestinaltract. Malignant carcinoid syndrome occurs whenserotonin and other vasoactive substances are releasedfromcarcinoidtumorcellsandresultinoneormoreofa constellation of symptoms which include flushing,hypotension, diarrhea and bronchospasm. More thanhalf of patients with carcinoid syndrome develop carci-noid heart disease as a late complication and it isassociated with progressive disease.

Carcinoid tumors.

Carcinoid tumors are rare, slow-growing neuroendocrine tumors arising from the enterochromaffin cells disseminated throughout the gastrointestinal and bronchopulmonary systems. Though they have been traditionally classified based on embryologic site of origin, morphologic pattern, and silver affinity, newer classification systems have been developed to emphasize the considerable clinical and histopathologic variability of carcinoid tumors found within each embryologic site of origin. These neoplasms pose a diagnostic challenge because they are often innocuous at the time of presentation, emphasizing the need for a multidisciplinary diagnostic approach using biochemical analysis, standard cross-sectional imaging, and newer advances in nuclear medicine. Similarly, treatment of both primary and disseminated carcinoid disease reflects the need for a multidisciplinary approach, with surgery remaining the only curative modality. The prognosis for patients with these tumors is generally favorable; however, it can be quite variable and is related to the location of the primary tumor, extent of metastatic disease at initial presentation, and time of diagnosis.

Myocardial Metastases of Carcinoid Visualized by 18 F-Dihydroxy-Phenyl-Alanine Positron Emission Tomography

Carcinoids are rare tumors arising from neuroendocrine cells that can produce and secrete hormones. Carcinoid disease may include cardiac involvement, with right-sided endocardial and valvular fibrous lesions of the heart.1 This so-called carcinoid heart disease may present with cardiac failure and arrhythmias. More uncommonly, myocardial metastases are diagnosed in carcinoid disease. The reported incidence of myocardial carcinoid metastases among patients with metastatic carcinoid disease is 4%.2 These metastases usually are discovered during screening for distant metastatic disease or carcinoid heart disease but also may present with arrhythmias. However, the incidence may be underestimated as a consequence of limited resolution of the imaging techniques used. In the past, myocardial metastases have been located with ultrasonography and somatostatin receptor scintigraphy (SRS). Lesions <1.0 cm are difficult to identify with ultrasonography, and although good sensitivity (92%) has been reported for SRS, it is …

Low plasma tryptophan in carcinoid patients is associated with increased urinary cortisol excretion

Previously we observed in patients suffering from a metastatic carcinoid tumor that irritability, aggression and lack of impulse control are associated with low levels of plasma tryptophan and presumably with low brain serotonin function. In rats we showed that a diet of low tryptophan resulted in higher stress responses and higher corticosterone production. Here we tested in carcinoid patients whether tryptophan depletion due to tumor 5-HT overproduction is associated with high cortisol production. Urinary excretion of cortisol, serotonin, 5-hydroxyindole acetic acid (the main metabolite of serotonin a marker of tumor activity), plasma levels of tryptophan and platelet content of serotonin (index of peripheral serotonin synthesis) were determined in metastatic midgut carcinoid patients. Patients (N = 25) were divided into two groups based on their plasma tryptophan levels (< or = 25 micromol/l, n = 12 and > or = 49 micromol/l, n = 13). Carcinoid patients with low plasma tryptophan levels had significantly higher urinary excretion of free cortisol (p < 0.01), independent of tumor activity. The inter-individual differences in the low tryptophan group, however, were substantial. In a subgroup of the patients suffering from metastatic carcinoid disease the cerebral access of plasma tryptophan is impaired, thus rendering cerebral serotonin neurotransmission suboptimal and leading to hypercortisolism. The present study provides further support to the idea that low serotonergic function is a risk for developing stress-associated psychopathology.

Multimodal cytoreduction for carcinoid liver metastases: analysis of a case series with highly advanced disease

BACKGROUND: The objective of our study was to assess the efficacy of multimodal hepatic cytoreduction in symptomatic patients with advanced hepatic metastases from carcinoid disease. METHODS: A retrospective analysis of prospectively collected data was performed. All consecutive patients, who underwent cytoreductive treatment for their metastatic carcinoid liver disease between October 1996 and October 2004, were enrolled. Treatment modalities included resection, radiofrequency with ethanol ablation, chemoembolization, or combined therapy. RESULTS: Fifteen patients, mean age 61 (SD 11) years, underwent cytoreduction. Twelve (80%) patients had extensive bilobar disease and 3 (20%) had solitary lesions. Eleven patients underwent one or more palliative surgical debulking procedures. Two patients had curative resection, and 2 patients had chemoembolization only due to unacceptable anesthesia risk. With a mean follow-up after 29 months (SD 22.1), 6 patients (40%) had stable disease, 8 (53.3%) had progression of disease and 1 (6.6%) had no disease at all. Death grasped 4 patients of which 2 died due to progression of disease. The median symptom relief period was 12 months. Overall survival was 57 months (mean) from the time of hepatic cytoreduction. CONCLUSIONS: Aggressive hepatic cytoreduction in patients with advanced metastatic carcinoid disease can achieve excellent overall survival but needs improvement in long-term symptom control.

Carcinoid syndrome

As clinical awareness increases, carcinoid is becoming increasingly identified, often at an earlier stage in the course of the disease. However, many patients remain undiagnosed until well into the late stages of the illness, at the time when their carcinoid syndrome becomes apparent. This review examines contemporary methods of detecting and assessing advanced carcinoid disease, and then continues to discuss strategies (both potentially curative and palliative) to control symptoms, and both prolong and improve quality of life for these patients.

Gluteal Nodules in Patients with Metastatic Midgut Carcinoid Disease Treated with Depot Somatostatin Analogs

We were referred a patient with metastatic well-differentiated endocrine tumor of the small intestine (midgut carcinoid) in whom asymptomatic sc gluteal nodules had been identified on routine abdominal computed tomography and labeled as metastases. This prompted us to assess the prevalence and cause of these nodules. This was a retrospective, cross-sectional study at a university teaching hospital. Routine abdominal computed tomography scans of 56 patients with metastatic midgut carcinoid were analyzed by two independent radiologists, blinded to treatment status (depot somatostatin analogs). Number of patients with nodules, number of injections, and duration and total cumulative dose per patient were assessed. No nodules were detected in 13 patients not on depot somatostatin therapy. Nodules were found in 29 of 43 patients (67%) on somatostatin analog therapy: 16 of 22 patients on lanreotide Autogel, five of 12 patients on octreotide LAR only, and eight of nine patients who had been treated with both somatostatin analogs. There was no difference in the clinical state of those with or without nodules. Per patient, the average number was seven, and average size was 1 cm. Presence of nodules was significantly associated with total number of injections (P = 0.024), duration on treatment (P = 0.022), and cumulative dose of lanreotide Autogel (P < 0.001). Nodules underwent involution on follow-up imaging. Patients with metastatic midgut carcinoid tumors have large numbers of asymptomatic sc nodules in the gluteal area when on either depot somatostatin analog, but these resolve over time. This clear observation gives reassurance to patients and those managing them that such nodules are unlikely to represent metastases.

Abstract No. 222: Chemoembolization Using Drug-Eluting Beads for Metastatic Carcinoid Disease

Trans-arterial hepatic bland embolization (TAE) and/or chemoembolization (TACE) are established palliative treatment for metastatic carcinoid with approximate response rates ranging from 45 to 70 percent. The purpose of this retrospective study was to describe a single institution’s experience with drug-eluting beads, specifically highlighting technical efficacy and medium-term radiologic follow-up.