[Liver metastases from neuroendocrine tumours of the gastroenteropancreatic system--therapeutic strategies].
Neuroendocrine tumours (NET) differ appreciably with regard to their biological behaviour from tumours of epithelial origin. In general this leads to a better 5-year survival rate. Liver metastases per se and also in cases of NET result in a significantly poorer survival in comparison to tumours without metastases. In contrast to those with epithelial tumours, about (2/3) of the NET patients already have liver metastases at the time of diagnosis. Thus, in spite of the rarity of these tumours, the surgeon is frequently confronted with this tumour entity. Among other factors the prognosis depends on the primary localisation of the NET (pancreatic NET poorer than non-pancreatic NET) as well as the staging and grading (proliferation index Ki-67) of the tumours. In this article, we characterise the surgical and ablative therapies for liver metastases from NET of the gastrointestinal tract from both curative and palliative points of view on the basis of the recently published guidelines of the ENETS (European Neuroendocrine Tumour Society). Furthermore, the various options for conservative therapy are discussed and assessed for their relative values. For localised tumour disease, also of both liver lobes, the resection of liver metastases (single or multi-stage operation, if necessary in combination with RFA) remains the standard therapy. Liver resections as debulking operations (target: resection of > 90 % tumour volume) with good preoperative planning can also be carried out under palliative criteria. For diffuse liver metastases with more than 50 % tumour volume in the liver, orthotopic liver transplantation, if necessary even as a multivisceral transplantation, may be considered in individual cases. For inoperable metastases, depending on the tumour load in the liver, the tumour localisation (intrahepatic versus intra- and extrahepatic), the tumour grading (proliferation index Ki-67), the dynamics of tumour growth, and the primary localisation of the tumour, differentiated biotherapy with somatostatin analogues, peptide-mediated radioreceptor therapy (PRRT), transarterial chemoembolisation (TACE) and selective intraarterial radiotherapy (SIRT), chemotherapy and new molecular target-directed therapy options can be employed. The utilities of these treatment options are presented and discussed.
Auernhammer
C J
CJ
Medizinische Klinik II, Campus Grosshadern, Klinikum der LMU München, Marchioninistrasse 15, Munich, Germany.
Jauch
K W
KW
Hoffmann
J N
JN
D003131:Combined Modality Therapy; D004067:Digestive System Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy / Q000556:secondary* / Q000601:surgery*; D016031:Liver Transplantation; D009367:Neoplasm Staging; D018358:Neuroendocrine Tumors / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy / Q000556:secondary* / Q000601:surgery*; D010166:Palliative Care; D017410:Practice Guidelines as Topic; D011379:Prognosis; D047368:Tumor Burden