Multimodal management of neuroendocrine liver metastases.
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.
Frilling
Andrea
A
Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, London, UK. a.frilling@imperial.ac.uk
Sotiropoulos
Georgios C
GC
Li
Jun
J
Kornasiewicz
Oskar
O
Plöckinger
Ursula
U
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D014408:Biomarkers, Tumor / Q000032:analysis; D001706:Biopsy; D017115:Catheter Ablation; D016461:Chemoembolization, Therapeutic; D003952:Diagnostic Imaging; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000556:secondary / Q000628:therapy*; D016031:Liver Transplantation; D018358:Neuroendocrine Tumors / Q000175:diagnosis / Q000401:mortality / Q000556:secondary / Q000628:therapy*; D010166:Palliative Care; D018579:Patient Selection; D018570:Risk Assessment; D016896:Treatment Outcome
D014408:Biomarkers, Tumor