title: Multimodal management of neuroendocrine liver metastases.
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.
authors.affiliation: Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, London, UK. a.frilling@imperial.ac.uk
authors.forename: Andrea
authors.initials: A
authors.lastname: Frilling
authors.forename: Georgios C
authors.initials: GC
authors.lastname: Sotiropoulos
authors.forename: Jun
authors.initials: J
authors.lastname: Li
authors.forename: Oskar
authors.initials: O
authors.lastname: Kornasiewicz
authors.forename: Ursula
authors.initials: U
authors.lastname: Plöckinger
mesh_terms: 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
chemical_list: D014408:Biomarkers, Tumor