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Review
. 2010 Aug;12(6):361-79.
doi: 10.1111/j.1477-2574.2010.00175.x.

Multimodal management of neuroendocrine liver metastases

Andrea Frilling  1 , Georgios C Sotiropoulos, Jun Li, Oskar Kornasiewicz, Ursula Plöckinger
Affiliations
Review

Multimodal management of neuroendocrine liver metastases

Andrea Frilling et al. HPB (Oxford). 2010 Aug.

Abstract

Background: The incidence of neuroendocrine tumours (NET) has increased over the past three decades. Hepatic metastases which occur in up to 75% of NET patients significantly worsen their prognosis. New imaging techniques with increasing sensitivity enabling tumour detection at an early stage have been developed. The treatment encompasses a panel of surgical and non-surgical modalities.

Methods: This article reviews the published literature related to management of hepatic neuroendocrine metastases.

Results: Abdominal computer tomography, magnetic resonance tomography and somatostatin receptor scintigraphy are widely accepted imaging modalities. Hepatic resection is the only potentially curative treatment. Liver transplantation is justified in highly selected patients. Liver-directed interventional techniques and locally ablative measures offer effective palliation. Promising novel therapeutic options offering targeted approaches are under evaluation.

Conclusions: The treatment of neuroendocrine liver metastases still needs to be standardized. Management in centres of expertise should be strongly encouraged in order to enable a multidisciplinary approach and personalized treatment. Development of molecular prognostic factors to select treatment according to patient risk should be attempted.

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Figures

Figure 1
Figure 1
Intraoperative finding in a patient with a 1 cm in size ileal neuroendocrine tumor, necrotic mesenterial lymph node metastases (a), and bilobar liver metastases (b)
Figure 2
Figure 2
68Ga-DOTATOC PET/CT revealing bilobar liver metastases and a neuroendocrine primary localized within the small bowel (arrow). The spleen shows physiological radionuclide accumulation
Figure 3
Figure 3
Evaluation and treatment decision for patients with well-differentiated neuroendocrine liver metastases. LM, liver metastases; CRR, cytoreductive resection; RFA, radiofrequency ablation; LT, liver transplantation; TACE, transcatheter arterial chemoembolization; SIRT, selective internal radiotherapy; PRRT, peptide receptor radionuclide therapy; EHD, extrahepatic disease; REHD, resection of extrahepatic disease; US, ultrasound; FNB, fine needle biopsy
See this image and copyright information in PMC

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