title: Hepatic cytoreduction followed by a novel long-acting somatostatin analog: a paradigm for intractable neuroendocrine tumors metastatic to the liver.
abstract: BACKGROUND
  Optimal management of symptomatic neuroendocrine tumors that metastasize to the liver is controversial. We investigated aggressive hepatic cytoreduction and postoperative administration of octreotide long-acting release (LAR), a long-acting somatostatin analog.
  
  
  METHODS
  Between December 1992 and August 2000, 31 patients underwent hepatic surgical cytoreduction (20 carcinoid, 10 islet cell, and 1 medullary). All patients had progressive symptoms refractory to conventional therapy.
  
  
  RESULTS
  Hepatic cytoreduction (resection, cryosurgery, and/or radiofrequency ablation) eliminated symptoms in 27 patients (87%) and decreased secretion of hormones by an overall mean of 59%. When minor symptoms returned and/or hormonal levels increased during follow-up, adjuvant therapy was started. Ten patients received adjuvant octreotide LAR once a month, and 21 received other adjuvants. At a median postoperative follow-up of 26 months, 16 patients had progressive/recurrent disease, 13 had died of their disease, and 2 remained free of disease. Median symptom-free interval was 60 months (95% confidence interval, 48-72) with octreotide LAR and 16 months (95% confidence interval, 10-29) with other adjuvants (P = .0007). Two-year symptom-free survival rate was 100% with octreotide LAR and 33% with other adjuvants.
  
  
  CONCLUSIONS
  Hepatic surgical cytoreduction can palliate progressive symptoms associated with liver metastases from intractable neuroendocrine tumors. Postoperative adjuvant therapy with octreotide LAR can prolong symptom-free survival.
authors.affiliation: John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, CA 90404, USA.
authors.forename: M H
authors.initials: MH
authors.lastname: Chung
authors.forename: J
authors.initials: J
authors.lastname: Pisegna
authors.forename: M
authors.initials: M
authors.lastname: Spirt
authors.forename: A E
authors.initials: AE
authors.lastname: Giuliano
authors.forename: W
authors.initials: W
authors.lastname: Ye
authors.forename: K P
authors.initials: KP
authors.lastname: Ramming
authors.forename: A J
authors.initials: AJ
authors.lastname: Bilchik
mesh_terms: D000328:Adult; D000368:Aged; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008099:Liver / Q000601:surgery*; D008113:Liver Neoplasms / Q000401:mortality / Q000556:secondary* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D018358:Neuroendocrine Tumors / Q000401:mortality / Q000556:secondary* / Q000628:therapy*; D015282:Octreotide / Q000627:therapeutic use*; D011446:Prospective Studies
chemical_list: D018931:Antineoplastic Agents, Hormonal; D015282:Octreotide