Transcatheter Arterial Chemoembolization of Liver Metastasis of Gastrointestinal Leiomyosarcoma

Won, Hyung Jin; Chung, Jin Wook; Kim, Tae Kyoung; Han, Daehee; Kim, Sun Ho; Cheon, Jung Eun; Han, Joon Koo; Park, Jae Hyung

Abstract

PURPOSE
To evaluate the usefulness of transcatheter arterial chemoembolization (TACE) in the management of gastrointestinal leiomyosarcoma metastatic to the liver.
MATERIALS AND METHODS
Ten patients with gastrointestinal leiomyosarcoma and hepatic metastasis underwent TACE after surgical resection of the primary tumor. All of the leiomyosarcomas originated from the stomach (n=5), duodenum (n=1) or jejunum(n=4), and the interval between primary tumor resection and hepatic metastasis was 1-120 (mean 26) months. Using an emulsion of 3-20 mL of Lipiodol and 15-60 mg of doxorubicin. TACE was performed, and in five patients, gelfoam embolization was added. Therapeutic response was evaluated by follow-up CT, and nine patients underwent repeated TACE (range :2-9 times ; interval : 1-9 months).
RESULTS
On celiac arteriography, all cases showed hypervascular tumor staining. As an initial therapeutic response based on CT assessment, more than 50% regression of the tumor (partial remission) was achieved in seven patients, and in the remaining three, regression was 20-30% (stable disease) ; neither complete remission nor progression was seen. With regard to long-term survival, five patients died at 5, 8, 14, 20 and 49 (median, 19) months after initial TACE. The remaining five, in whom follow-up has extended for 13-54 months, are still alive. Overall, survival time ranged from 5-54 (median, 19) months, and except for postembolization syndrome, there was no specific complication. The period of durable tumor regression before progression ranged from 6 to 54 (median, 17) months.
CONCLUSION
TACE can be a safe and effective method for the palliation of gastrointestinal leiomyosarcoma metastatic to the liver.