title: Liver-directed therapy for neuroendocrine neoplasm hepatic metastasis prolongs survival following progression after initial surgery.
abstract: BACKGROUND
  Surgery confers the best chance of long-term survival in patients with neuroendocrine neoplasm hepatic metastases (NENHM). Disease progression invariably occurs in the majority of patients. No previous study has addressed the outcomes after treatment of hepatic disease progression in patients who initially underwent surgical extirpation of NENHM. This was the principal aim of the current study.
  
  
  METHODS
  Seventy-four patients with NENHM underwent surgery for NENHM between December 1992 and December 2009. Of these, 50 patients developed disease progression in the liver. These patients were then treated with specific liver-directed therapies according to consensus of a multidisciplinary team. The current study evaluates progression-free survival (PFS) and overall survival (OS) following treatment of hepatic disease progression with specific liver-directed therapies.
  
  
  RESULTS
  No patient was lost to follow up. The median follow-up after treatment of progression was 29 months (range = 2-137). The median PFS and OS after diagnosis of disease progression were 15 and 48 months, respectively. Specific liver-directed therapies included surgery in 10 patients, radioembolization in 15, cytotoxic chemotherapy in 14, and conservative therapy in 11. Four independent factors associated with PFS and OS were identified through a multivariate analysis. These were initial progression-free survival (PFS, P = 0.006, HR= 0.32), extra-hepatic disease (OS, P = 0.029, HR = 4.04; PFS, P = 0.004, HR = 4.03), histological grade (PFS, P = 0.006, HR = 4.08), and type of secondary intervention (PFS, P = 0.024, HR = 0.63).
  
  
  CONCLUSIONS
  A multimodality approach towards treatment of disease progression as shown in this study that includes repeat surgery or radioembolization has been shown to achieve a superior outcome in the setting of disease progression/recurrence.
authors: UNSW Department of Surgery, St George Hospital, Kogarah, Sydney, New South Wales, Australia.
authors: Akshat
authors: A
authors: Saxena
authors: Terence C
authors: TC
authors: Chua
authors: Jing
authors: J
authors: Zhao
authors: David L
authors: DL
authors: Morris
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D017115:Catheter Ablation; D003131:Combined Modality Therapy; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality* / Q000556:secondary / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D018358:Neuroendocrine Tumors / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D011446:Prospective Studies; D012189:Retrospective Studies; D024162:Second-Look Surgery; D015996:Survival Rate; D016896:Treatment Outcome