title: Role of hepatic intra-arterial therapies in metastatic neuroendocrine tumours (NET): guidelines from the NET-Liver-Metastases Consensus Conference.
abstract: OBJECTIVE
  Liver metastasis from a neuroendocrine tumour (NET) represents a significant clinical entity. A multidisciplinary group of experts was convened to develop state-of-the-art recommendations for its management.
  
  
  METHODS
  Peer-reviewed published reports on intra-arterial therapies for NET hepatic metastases were reviewed and the findings presented to a jury of peers. The therapies reviewed included transarterial embolization (TAE), transarterial chemoembolization (TACE) and radioembolization (RE). Two systems were used to evaluate the level of evidence in each publication: (i) the US National Cancer Institute (NCI) system, and (ii) the GRADE system.
  
  
  RESULTS
  Eighteen publications were reviewed. These comprised 11 reports on TAE or TACE and seven on RE. Four questions posed to the panel were answered and recommendations offered.
  
  
  CONCLUSIONS
  Studies of moderate quality support the use of TAE, TACE and RE in hepatic metastases of NETs. The quality and strength of the reports available do not allow any modality to be determined as superior in terms of imaging response, symptomatic response or impact on survival. Radioembolization may have advantages over TAE and TACE because it causes fewer side-effects and requires fewer treatments. Based on current European Neuroendocrine Tumor Society (ENETS) Consensus Guidelines, RE can be substituted for TAE or TACE in patients with either liver-only disease or those with limited extrahepatic metastases.
authors.affiliation: Radiation Oncology Research, Sarah Cannon Research Institute, Nashville, TN, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Kennedy
authors.forename: Lourens
authors.initials: L
authors.lastname: Bester
authors.forename: Riad
authors.initials: R
authors.lastname: Salem
authors.forename: Ricky A
authors.initials: RA
authors.lastname: Sharma
authors.forename: Rowan W
authors.initials: RW
authors.lastname: Parks
authors.forename: Philippe
authors.initials: P
authors.lastname: Ruszniewski
mesh_terms: D016461:Chemoembolization, Therapeutic / Q000009:adverse effects / Q000379:methods / Q000401:mortality / Q000592:standards*; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000379:methods / Q000401:mortality / Q000592:standards*; D006499:Hepatic Artery; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000556:secondary* / Q000628:therapy*; D018358:Neuroendocrine Tumors / Q000401:mortality / Q000556:secondary* / Q000628:therapy*; D018579:Patient Selection; D019275:Radiopharmaceuticals / Q000008:administration & dosage* / Q000009:adverse effects; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D019275:Radiopharmaceuticals