title: Cryotherapy treatment of patients with hepatic metastases from neuroendocrine tumors.
abstract: BACKGROUND
  Liver metastases from neuroendocrine tumors often present with disabling symptoms due to syndromes of hormonal excess. A locally destructive technique such as hepatic cryotherapy not only alleviates symptoms but may improve survival in this group of patients.
  
  
  METHODS
  Six patients with metastatic neuroendocrine tumors were treated with hepatic cryotherapy. Four patients were symptomatic and three of these had elevated tumor markers from ectopic hormone production.
  
  
  RESULTS
  All patients are alive and asymptomatic, with a median follow-up of 24 months (range, 6 months to 6 years). All have had a complete radiologic response. All with elevated preoperative markers have had a greater than 89% decrease in tumor markers. Coagulopathy occurred in two patients necessitating additional surgery, but there was no other morbidity attributable to the cryotherapy.
  
  
  CONCLUSIONS
  To the authors' knowledge, this study demonstrates for the first time that hepatic cryotherapy offers supportive treatment for patients with neuroendocrine tumors metastatic to the liver. Cryotherapy alleviates symptoms and may improve survival.
authors.affiliation: University Department of Surgery, University of New South Wales, St. George Hospital, Sydney, Australia.
authors.forename: P J
authors.initials: PJ
authors.lastname: Cozzi
authors.forename: R
authors.initials: R
authors.lastname: Englund
authors.forename: D L
authors.initials: DL
authors.lastname: Morris
mesh_terms: D007516:Adenoma, Islet Cell / Q000473:pathology; D000328:Adult; D002276:Carcinoid Tumor / Q000556:secondary / Q000601:surgery; D003452:Cryosurgery; D006801:Humans; D007414:Intestinal Neoplasms / Q000473:pathology; D008113:Liver Neoplasms / Q000556:secondary* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D018358:Neuroendocrine Tumors / Q000556:secondary* / Q000601:surgery; D010190:Pancreatic Neoplasms / Q000473:pathology; D010235:Paraganglioma / Q000556:secondary / Q000601:surgery