title: Gastrointestinal neuroendocrine tumor with unresectable liver metastases: an example of multimodal therapeutic approach.
abstract: Gastrointestinal neuroendocrine tumors (NET) frequently present with unresectable hepatic metastases, which poses a barrier for curative treatment. Resection of the primary tumor and subsequent orthotopic liver transplantation (OLT) has been proposed as a treatment approach but available data in this regard is limited. We present a clinical case of an otherwise asymptomatic 44-yo man complaining of abdominal pain and dyspepsia that was diagnosed of a 10 cm duodenal tumor with multiple hepatic metastases. A CT-guided biopsy confirmed a NET. He underwent first a Whipple's procedure, and then was listed for liver transplantation. During the waiting time a multimodal therapeutic approach was used including the use of radioactive 177lutetium-labeled somatostatin analogues, long-acting somastostatin analogues and antiangiogenic antibodies (bevacizumab) in order to keep neoplastic disease under control. Two years after Whipple's procedure and given disease stability he underwent OLT with an uneventful postoperative evolution. Patient condition and graft function are optimal after a 4-year follow-up period with no evidence of recurrence. This case report underscores how a multimodal approach involving careful patient selection, resective surgery as well as use of somatostatin analogues and antiangiogenic biological therapy followed by liver transplantation can achieve excellent long-term results in this difficult patient population.
authors.affiliation: Departments of School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
authors.forename: Jorge
authors.initials: J
authors.lastname: Martínez
authors.affiliation: Departments of School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
authors.forename: Santiago
authors.initials: S
authors.lastname: Besa
authors.affiliation: Gastrointestinal Surgery School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
authors.forename: Juan P
authors.initials: JP
authors.lastname: Arab
authors.affiliation: Radiology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
authors.forename: Juan C
authors.initials: JC
authors.lastname: Quintana
authors.affiliation: Oncology Unit, Clinica Las Condes, Santiago, Chile.
authors.forename: Carlos
authors.initials: C
authors.lastname: Regonesi
authors.affiliation: Radiology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
authors.forename: Alvaro
authors.initials: A
authors.lastname: Huete
authors.affiliation: Departments of School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
authors.forename: Nicolás
authors.initials: N
authors.lastname: Jarufe
authors.affiliation: Departments of School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
authors.forename: Juan F
authors.initials: JF
authors.lastname: Guerra
authors.affiliation: Gastrointestinal Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
authors.forename: Carlos
authors.initials: C
authors.lastname: Benítez
authors.affiliation: Gastrointestinal Surgery, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
authors.forename: Marco
authors.initials: M
authors.lastname: Arrese
mesh_terms: D000328:Adult; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use*; D000068258:Bevacizumab / Q000627:therapeutic use*; D014408:Biomarkers, Tumor / Q000032:analysis; D059186:Chemoradiotherapy, Adjuvant; D004379:Duodenal Neoplasms / Q000737:chemistry / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007150:Immunohistochemistry; D008113:Liver Neoplasms / Q000737:chemistry / Q000556:secondary / Q000628:therapy*; D016031:Liver Transplantation; D008279:Magnetic Resonance Imaging; D008297:Male; D018358:Neuroendocrine Tumors / Q000737:chemistry / Q000556:secondary / Q000628:therapy*; D049268:Positron-Emission Tomography; D019275:Radiopharmaceuticals / Q000627:therapeutic use*; D013004:Somatostatin / Q000031:analogs & derivatives / Q000627:therapeutic use*; D016708:Synaptophysin / Q000032:analysis; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014850:Waiting Lists
chemical_list: D020533:Angiogenesis Inhibitors; D014408:Biomarkers, Tumor; D019275:Radiopharmaceuticals; C569014:SYP protein, human; D016708:Synaptophysin; D000068258:Bevacizumab; D013004:Somatostatin