title: Treatment of liver metastases in patients with digestive neuroendocrine tumors.
abstract: BACKGROUND
  Liver metastases are a strong prognostic indicator in patients with gastro-entero-pancreatic neuroendocrine tumors (GEP-NETs). Therapeutic options for metastatic NETs are expanding and not mutually exclusive.
  
  
  OBJECTIVE
  This paper reviews the literature relating to multidisciplinary approach towards GEP-NET metastases, to highlight advances in knowledge regarding these tumors, and to understand the interdisciplinary management of individual patients.
  
  
  METHODS
  A PubMed search was performed for English-language publications from 1995 through 2012. Reference lists from studies selected were manually searched to identify further relevant reports. Manuscripts comparing different therapeutic options and advances for GEP-NET-related liver metastases were selected.
  
  
  RESULTS
  There is considerable controversy regarding the optimal management of GEP-NET metastases. Although radical surgery still remains the gold standard, a variety of other therapeutic options are available for metastatic GEP-NETs, including loco-regional chemotherapy/radiotherapy, radioembolization, systemic peptide receptor radionuclide therapy, biotherapy, and chemotherapy. In selected patients, liver transplantation should also be considered. Systemic somatostatin analogues and/or interferon show anti-proliferative effects, representing an appropriate first-line treatment for most patients. In advanced metastatic NETs, recent options include targeted therapies (i.e., everolimus and sunitinib).
  
  
  CONCLUSIONS
  It is evident that multidisciplinary care and multimodality treatments remain the cornerstone of management of NET patients. Since NETs often show a more indolent behavior compared to other malignancies, physicians should aim to preserve a satisfactory quality of life for the patient by personalizing the therapeutic approach according to the tumor's features and prognostic factors.
authors: Postgraduate School of Gastroenterology, Università degli Studi di Milano, Milan, Italy. robertaelisa.rossi@gmail.com
authors: Roberta Elisa
authors: RE
authors: Rossi
authors: Sara
authors: S
authors: Massironi
authors: Matilde Pia
authors: MP
authors: Spampatti
authors: Dario
authors: D
authors: Conte
authors: Clorinda
authors: C
authors: Ciafardini
authors: Federica
authors: F
authors: Cavalcoli
authors: Maddalena
authors: M
authors: Peracchi
mesh_terms: D055011:Ablation Techniques; D000970:Antineoplastic Agents / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D003131:Combined Modality Therapy; D004067:Digestive System Neoplasms / Q000473:pathology*; D004621:Embolization, Therapeutic / Q000379:methods; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary* / Q000628:therapy*; D016031:Liver Transplantation; D018358:Neuroendocrine Tumors / Q000556:secondary* / Q000628:therapy*; D011878:Radiotherapy / Q000379:methods; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents