Use of arterial devascularization and cytotoxic drugs in 30 patients with the carcinoid syndrome.

Thirty patients with symptoms of the carcinoid syndrome and other symptoms not controlled by pharmacological agents were analysed with respect to the value of various treatment measures used. Tumour devascularization was carried out in 11 patients, either by surgical ligation of the main hepatic artery (6) or by percutaneous arterial embolization (5). The latter was shown to be the safer technique, both with respect to initial morbidity/mortality and other side effects. Control of flushing and diarrhoea was achieved in 80% and the technique was also repeated on one occasion with success when symptoms recurred. The use of cytotoxic drugs alone, including 5-fluorouracil, cyclophosphamide and Adriamycin produced symptomatic relief in only 4 of the 22 patients treated. They should only be considered if devascularization by arterial embolization proves impossible or cannot be repeated when symptoms recur.