Currently available treatment options for neuroendocrine liver metastases

Abstract

Neuroendocrine neoplasms (NEN) are frequently characterized by a high propensity for metastasis to the liver, which appears to be a dominant site of distant-stage disease, affecting quality of life and overall survival. Liver surgery with the intention to cure is the treatment of choice for resectable neuroendocrine liver metastases (NELM), aiming to potentially prolong survival and ameliorate hormonal symptoms refractory to medical control. Surgical resection is indicated for patients with NELM from well-differentiated NEN, while its feasibility and complexity are largely dictated by the degree of liver involvement. As a result of advances in surgical techniques over the past decades, complex 1- and 2-stage, or repeat liver resections are performed safely and effectively by experienced surgeons. Furthermore, liver transplantation for the treatment of NELM should be anchored in a multimodal and multidisciplinary therapeutic strategy and restricted only to highly selected individual cases. A broad spectrum of interventional radiology treatments for NELM have recently been available, with expanding indications that are more applicable, as they are less limited by patient- and tumor-related parameters, being therefore important adjuncts or alternatives to surgery. Overall, liver-targeted treatment modalities may precede the administration of systemic molecular targeted agents and chemotherapy for patients with liver-dominant metastatic disease; these appear to be a crucial component of multimodal management of patients with NEN. In the present review, we discuss surgical and non-surgical liver-targeted treatment approaches for NELM, each complementing the other, with a view to assisting physicians in optimizing multimodal NEN patient care.

Factors Affecting Survival Outcomes in Neuroendocrine Tumor of the Appendix over the Past Two Decades

“…Tumors sized between 1.0 and 1.9 cm have a higher likelihood of nodal metastasis; however, studies indicate that right hemicolectomy does not confer benefits for these patients, with such intervention reserved for tumors exceeding 2 cm in size [33]. Surgical excision for metastatic NET tumors may still be considered, particularly for patients with symptomatic liver metastases, aiming to alleviate symptoms [16]. Newer guidelines show that simple appendicectomy would suffice for tumors less than the size of 1 cm and right hemicolectomy may be warranted for tumors > 2 cm.…”

“…Liver-directed therapy is recommended for patients in which tumors are metastatic to the liver and surgical procedures are not feasible. However, prospective and retrospective trials for this therapy are very limited [16][17][18]. A novel therapy to treat aNETs is radiolabeled somatostatin analog therapy [19].…”

Differenzierte Therapiestrategie bei Lebermetastasen gastro-entero-pankreatischer Neuroendokriner Neoplasien

“…Die unterschiedlichen Selektionskriterien, die bisher entwickelt wurden, berücksichtigen v. a. Alter, gut differenzierte NEN, stabilen Krankheitsverlauf nach Primariusresektion und z. T. auch Ausschluss extrahepatischer Metastasierung [35].…”

Liver-Directed Locoregional Therapies for Neuroendocrine Liver Metastases: Recent Advances and Management

“…However, in recent years, there has been a notable emergence of innovative treatment modalities, which may not aim to achieve a cure, but focus on alleviating symptoms, prolonging survival, and improving quality of life [9,13]. Within the battery of treatment approaches for NELM, non-surgical methods including catheter-driven and percutaneous approaches have emerged as adjuncts or viable alternatives to surgery [14]. In the present review, we discuss locoregional therapy approaches for NELM, highlighting the current evidence for their use as well as future areas of investigation.…”