Transcatheter Arterial Chemoembolization of Liver Metastasis of Gastrointestinal Leiomyosarcoma

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 (range2-9 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.