Treatment Of Metastatic Islet Cell Cancers

Surgical debulking should be the first consideration for hepatic metastases from functional endocrine tumors when greater than 90% of the tumor mass can be removed.55 Substantial prolonged palliation and probably prolonged survival can be achieved with low morbidity and mortality rates.56 Surgical debulking may take the form of resection or ablation by either cryotherapy or radiofrequency probes or a combination of techniques.

When surgical options have been exhausted, medical therapy or hepatic artery chemoembolization may offer benefits. Streptozocin and doxorubicin (Adri-amycin) chemotherapy has been associated with a 69% response rate and improved endocrine symptoms

Catheter for sampling

Catheter for sampling

Figure 15-10. Selective arterial secretin injection test. This is a graphical demonstration of the select arterial secretin injection test in which catheters are placed selectively in the mesenteric vessels to inject the secretagogue secretin. Blood samples are obtained from a catheter in the hepatic vein. This test was originally described by Dr. Imamura. CHA = common hepatic artery; GDA = gastroduo-denal artery; SA = splenic artery; SMA = superior mesenteric artery.

Figure 15-10. Selective arterial secretin injection test. This is a graphical demonstration of the select arterial secretin injection test in which catheters are placed selectively in the mesenteric vessels to inject the secretagogue secretin. Blood samples are obtained from a catheter in the hepatic vein. This test was originally described by Dr. Imamura. CHA = common hepatic artery; GDA = gastroduo-denal artery; SA = splenic artery; SMA = superior mesenteric artery.

Time after secretin injection(s) Figure 15-11. Selective intra-arterial secretin test. The results of this particular patient's assay demonstrate a gastrinoma in the distribution of the gastroduodenal artery. An injection of secretin into the gastroduodenal artery resulted in a rapid increase in the gastrin level of the hepatic vein blood. SMA = superior mesenteric artery for up to 18 months.571 have seen encouraging results using hepatic artery chemoembolization in small series of patients with unresectable metastatic disease confined to the liver. This treatment is based on the observation that metastatic foci are predominantly supplied by branches of the hepatic artery. Chemother-apeutic agents injected into the hepatic artery reach the tumor directly and at 20 to 200 times the levels achieved by peripheral venous injection. Embolization of the hepatic artery deprives the tumor of oxygen and slows washout of the injected drugs, thereby enhancing their effect and decreasing systemic adverse reactions. The parenchyma of the liver is spared by virtue of the portal venous inflow. The protocol at our institution uses a three-drug regimen consisting of doxorubicin, mitomycin, and cisplatin. We have treated a small number of patients without apparent toxicity and good palliation of endocrine symptoms.

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