, Volume 16, Issue 10, pp 1981-1992
Date: 25 Jul 2012

Treatment of Liver Metastases in Patients with Digestive Neuroendocrine Tumors

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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.

Aims

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.

Author Contributions

Rossi Roberta Elisa and Massironi Sara planned the work; Rossi Roberta Elisa, Spampatti Matilde Pia, and Cavalcoli Federica performed the literature search; Massironi Sara and Rossi Roberta Elisa wrote the first draft of the manuscript; Rossi Roberta Elisa and Massironi Sara edited subsequent versions of the manuscript; Conte Dario and Peracchi Maddalena corrected the final version; Rossi Roberta Elisa, Massironi Sara, Conte Dario, Clorinda Ciafardini, and Peracchi Maddalena wrote the revised version of the manuscript.