14.7 Conclusion
Current management strategies for neuroendocrine tumor hepatic metastases have relied on data from anecdotal evidence and retrospective studies involving small numbers of patients. It is unlikely that this situation will change in the near future, since prospective studies are difficult to perform in such a relatively rare and biologically heterogeneous disease. Embolotherapy is a widely accepted method of treatment for nonresectable hepatic metastases from neuroendocrine tumors. Long-term palliation of pain and hormonal symptoms is possible using repeated treatment. Both bland hepatic artery embolization and chemoembolization have been used, and there is no conclusive data to indicate which embolization method and which embolic agents are most efficacious.
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsPreview
Unable to display preview. Download preview PDF.
References
Lepage C, Bouvier AM, Phelip JM, et al. (2004) Incidence and management of malignant digestive endocrine tumours in a well defined French population. Gut 53:549–553
Moertel CG (1987) An odyssey in the land of small tumors. J Clin Oncol 5:1503–1522
Soreide O, Berstad T, Bakka A (1992) Surgical treatment as a principle in patients with advanced abdominal carcinoid tumors. Surgery 111:48
Hemminki K, Li X (2001) Incidence trends and risk factors of carcinoid tumors: a nationwide epidemiologic study from Sweden. Cancer 92:2204–10
Quaedvlieg PF, Visser O, Lamers CB, et al. (2001) Epidemiology and survival in patients with carcinoid disease in The Netherlands. An epidemiological study with 2391 patients. Ann Oncol 12:1295–300
Hochwald SN, Zee S, Conlon KC, et al. (2002) Prognostic factors in pancreatic endocrine neoplasms: an analysis of 136 cases with a proposal for low-grade and intermediate-grade groups. J Clin Oncol 20:2633–42
Shebani KO, Souba WW, Finkelstein DM, et al. (1999) Prognosis and survival in patients with gastrointestinal tract carcinoid tumors. Ann Surg 229:815–21
Madeira I, Terris B, Voss M, et al. (1998) Prognostic factors in patients with endocrine tumours of the duodenopancreatic area. Gut 43:422–7
Godwin JD II (1975) Carcinoid tumors: An analysis of 2837 cases. Cancer 36:560–569
Zeitels J, Naunheim K, Kaplan EL, et al. (1982) Carcinoid tumors: A 37 year experience. Arch Surg 117:732–737
Mignon M, Ruszniewski P, Haffar S, et al. (1986) Current approach to the management of tumoral process in patients with gastrinoma. World J Surg 10:703–710
Creutzfeldt W (1996) Carcinoid tumors: development of our knowledge. World J Surg 20:126–131
Arnold R, Frank M, Kajdan U (1994) Management of gastroenteropancreatic endocrine tumors: The place of somatostatin analogues. Digestion 55(Suppl 3):107–113
Öberg K, Erikson B (1989) Medical treatment of neuroendocrine gut and pancreatic tumors. Acta Oncol 28:425–431
Ruszniewski P, Ducreux M, Chayvialle JA, et al. (1996) Treatment of the carcinoid syndrome with the long acting somatostatin analogue lanreotide: a prospective study in 39 patients. Gut 39:279–283
Arnold R (1996) Medical treatment of metastasizing carcinoid tumors. World J Surg 20:203–207
Eriksson B, Skogseid B, Lundqvist G, et al. (1990) Medical treatment and long-term survival in a prospective study of 84 patients with endocrine pancreatic tumors. Cancer 65:1883–1890
Chiti A, Fanti S, Savelli G, et al. (1998) Comparison of somatostatin receptor imaging, computed tomography and ultrasound in the clinical management of neuroendocrine gastroentero-pancreatic tumours. Eur J Nucl Med 25:1396–1403
Gibril F, Reynolds JC, Doppman JL, et al. (1996) Somatostatin receptor scintigraphy: its sensitivity compared with that of other imaging methods in detecting primary and metastatic gastrinomas. A prospective study. Ann Intern Med 125:26–34
Frucht H, Doppman JL, Norton JA, et al. (1989) Gastrinomas: comparison of MR imaging with CT, angiography, and US. Radiology 171:713–717
Zimmer T, Ziegler K, Bader M, et al. (1994) Localization of neuroendocrine tumours of the upper gastrointestinal tract. Gut 35:471–475
Zimmer T, Stolzel U, Bader M, et al. (1996) Endoscopic ultrasonography and somatostatin receptor scintigraphy in the preoperative localization of insulinomas and gastrinomas. Gut 39:562–568
Anthuber M, Jauch KW, Briegel J, et al. (1996) Results of liver transplantation for gastroenteropancreatic tumor metastases. World J Surg 20:73–76
Ahlman H, Westberg G, Wangberg B, et al. (1996) Treatment of liver metastases of carcinoid tumors. World J Surg 20:196–202
Chamberlain RS, Canes D, Brown KT, et al. (2000) Hepatic neuroendocrine metastases: Does intervention alter outcomes? J Am Coll Surg 190:432–445
Chen H, Hardacre JM, Uzar A, et al. (1998) Isolated liver metastases from neuroendocrine tumors: does resection prolong survival? J Am Coll Surg 187:88–93
Dominguez S, Denys A, Menu Y, et al. (1999) Hepatic arterial chemoembolization in the management of advanced digestive endocrine tumours. Ital J Gastroenterol Hepatol 31(Suppl 2):213–215
McEntee GP, Nagorney DM, Kvols LK, et al. (1990) Cytoreductive hepatic surgery for neuroendocrine tumors. Surgery 108:1091–1096
Soreide O, Berstad T, Bakka A, et al. (1992) Surgical treatment as a principle in patients with advanced abdominal carcinoid tumors. Surgery 111:48–54
Yao KK, Talamonti MS, Nemcek A, et al. (2001) Indications and results of liver resection and hepatic chemoembolization for metastatic gastrointestinal neuroendocrine tumors. Surgery 130:677–685
Benevento A, Boni L, Frediani L, et al. (2000) Result of liver resection as treatment for metastases from noncolorectal cancer. J Surg Oncol 74:24–29
Grazi GL, Cescon M, Pierangeli F, et al. (2000) Highly aggressive policy of hepatic resections for neuroendocrine liver metastases. Hepatogastroenterology 47:481–486
Que FG, Nagorney DM, Batts KP, et al. (1995) Hepatic resection for metastatic neuroendocrine carcinomas. Am J Surg 169:36–42
Akerstrom G (1996) Management of carcinoid tumors of the stomach, duodenum, and pancreas. World J Surg 20:173–182
Faiss S, Scherubl H, Riecken EO, et al. (1996) Drug therapy in metastatic neuroendocrine tumors of the gastroentero-pancreatic system. Recent Results Cancer Res 142:193–207
di Bartolomeo M, Bajetta E, Buzzoni R, et al. (1996) Clinical efficacy of octreotide in the treatment of metastatic neuroendocrine tumors. A study by the Italian Trials in Medical Oncology Group. Cancer 77:402–408
Moertel CG, Hanley JA (1979) Combination chemotherapy trials in metastatic carcinoid tumor and the malignant carcinoid syndrome. Cancer Clin Trials 2:327–334
Oberg K, Norheim I, Lundqvist G, et al. (1987) Cytotoxic treatment in patients with malignant carcinoid tumors. Response to streptozocin—alone or in combination with 5 FU. Acta Oncol 26:429–432
Moertel CG, Lefkopoulo M, Lipsitz S, et al. (1992) Streptozocin-doxorubicin, streptozocin-fluorouracil, or chlorozotocin in the treatment of advanced islet-cell carcinoma. N Engl J Med 326:519–523
Rivera E, Ajani JA (1998) Doxorubicin, streptozocin, and 5-fluorouracil chemotherapy for patients with metastatic islet-cell carcinoma. Am J Clin Oncol 21:36–38
Gray RK, Rosch J, Grollman JH (1970) Arteriography in the diagnosis of islet-cell tumors. Radiology 97:39–44
Andersson M, Aronsen F, Balch C, et al. (1989) Pharmacokinetics of intra-arterial mitomycin-c with or without degradable starch microspheres (DSM) in the treatment of non-resectable liver cancer. Acta Oncol 28:219–222
Ruszniewski P, Malka D (2000) Hepatic arterial chemoembolization in the management of advanced digestive endocrine tumors. Digestion 62(suppl 1):79–83
Sutcliffe R, Maguire D, Ramage J, et al. (2004) Management of neuroendocrine liver metastases Am J Surg 187:39–46
Norton JA, Warren RS, Kelly MG, et al. (2003) Aggressive surgery for metastatic liver neuroendocrine tumors. Surgery 134:1057–1063
Sarmiento JM, Heywood G, Rubin J, et al. (2003) Surgical treatment of neuroendocrine metastases to the liver: a plea for resection to increase survival. J Am Coll Surg 197:29–37
Eriksson BK, Larsson EG, Skogseid BM, et al. (1998) Liver embolizations of patients with malignant neuroendocrine gastrointestinal tumors. Cancer 83:2293–2301
Brown KT, Koh BY, Brody LA, et al. (1999) Particle embolization of hepatic metastases for control of pain and hormonal symptoms. J Vasc Interv Radiol 10:397–403
Rivera E, Ajani JA (1998) Doxorubicin, streptozocin, and 5-fluorouracil chemotherapy for patients with metastatic islet-cell carcinoma. Am J Clin Oncol 21:36–38
Faiss S, Pape UF, Bohmig M, et al. (2003) Prospective, randomized, multicenter trial on the antiproliferative effect of lanreotide, interferon alfa, and their combination for therapy of metastatic neuroendocrine gastroenteropancreatic tumors—The International Lanreotide and Interferon Alfa Study Group. J Clin Oncol 21:2689–2696
De Jong M, Breeman WA, Bernard HF, et al. (1999) Therapy of neuroendocrine tumors with radiolabeled somatostatin-analogues. Q J Nucl Med 43:356–66
Mukherjee JJ, Kaltsas GA, Islam N, et al. (2001) Treatment of metastatic carcinoid tumours, phaeochromocytoma, paraganglioma and medullary carcinoma of the thyroid with (131)I-meta-iodobenzylguanidine [(131)I-mIBG]. Clin Endocrinol 55:47–60
Castellani MR, Chiti A, Seregni E, et al. (2000) Role of 131Imetaiodobenzylguanidine (MIBG) in the treatment of neuroendocrine tumours. Experience of the National Cancer Institute of Milan. Q J Nucl Med 44:77–87
Chatal JF, Le Bodic MF, Kraeber-Bodere F, et al. (2000) Nuclear medicine applications for neuroendocrine tumors. World J Surg 24:1285–9
Chatziioannou A, Ladopoulos C, Limouris GS, et al. (2004) Selective intraarterial injection of 111In-pentetreotide in the treatment of somatostatin positive (receptors II, SSTR2) neuroendocrine metastatic disease in the liver. CIRSE 2004, Barcelona. Poster 150
Le Treut YP, Delpero JR, Dousset B, et al. (1997) Results of liver transplantation in the treatment of metastatic neuroendocrine tumors. A 31-case French multicentric report. Ann Surg 225:355–364
Dousset B, Houssin D, Soubrane O, et al. (1995) Metastatic endocrine tumors: is there a place for liver transplantation? Liver Transpl Surg 1:111–117
Knechtle SJ, Kalayoglu M, D’Alessandro AM, et al. (1997) Proceed with caution: liver transplantation for metastatic neuroendocrine tumors. Ann Surg 225:345–346
Lang H, Oldhafer KJ, Weimann A, et al. (1997) Liver transplantation for metastatic neuroendocrine tumors. Ann Surg 225:347–354
Coppa J, Pulvirenti A, Schiavo M, et al. (2001) Resection versus transplantation for liver metastases from neuroendocrine tumors. Transplant Proc 33:1537–1539
Perry LJ, Stuart K, Stokes KR, et al. (1994) Hepatic arterial chemoembolization for metastatic neuroendocrine tumors. Surgery 116:1111–1116
Drougas JG, Antony LB, Blair TK, et al. (1998) Hepatic artery chemoembolization for management of patients with advanced metastatic carcinoid tumors. Am J Surg 175:408–412
Kim YH, Ajani JA, Carrasco CH, et al. (1999) Selective hepatic arterial chemoembolization for liver metastases in patients with carcinoid tumor or islet cell carcinoma. Cancer Invest 17:474–478
Roche A, Girish BV, de Baere T, et al. (2003) Trans-catheter arterial chemoembolization as first-line treatment for hepatic metastases from endocrine tumors. Eur Radiol 13:136–140
Schell SR, Camp RE, Caridi JG, et al. (2002) Hepatic Artery Embolization for Control of Symptoms, Octreotide Requirements, and Tumor Progression in Metastatic Carcinoid Tumors. J Gastrointest Surg 6:664–670
Winkelbauer FW, Niederle B, Pietschmann F (1995) Hepatic artery embolotherapy of hepatic metastases from carcinoid tumors: value of using a mixture of cyanoacrylate and ethiodized oil. Am J Roentgenol 165:323–327
Stokes KR, Stuart K, Clouse ME (1993) Hepatic arterial chemoembolization for metastatic endocrine tumors. J Vasc Interv Radiol 4:341–345
Hartnell GG, Gates J, Stuart K, et al. (1999) Hepatic chemoembolization: effect of intraarterial lidocaine on pain and postprocedure recovery. Cardiovasc Intervent Radiol 22:293–297
Clouse ME, Perry L, Stuart K, et al. (1994) Hepatic arterial chemoembolization for metastatic neuroendocrine tumors. Digestion 55(suppl 3):92–97
Lem SL, Asch M, Kachura JR, et al. (2004) Toronto hepatic artery embolization study. J Vasc Interv Radiol 15:S245 [Poster No. 297 presented at 29th Annual Scientific Meeting of the Society of Interventional Radiology, Phoenix, Arizona, March 25–30, 2004]
Pentecost MJ, Daniels JR, Teitelbaum GP, et al. (1993) Hepatic chemoembolization: safety with portal vein thrombosis. J Vasc Intervent Radiol 4:347–351
Gates J, Hartnell GG, Stuart KE, et al. (1999) Chemoembolization of hepatic neoplasms: safety, complications, and when to worry. Radiographics 19:399–414
Carrasco CH, Charnsangavej C, Ajani J, et al. (1986) The carcinoid syndrome: palliation by hepatic artery embolization. Am J Roentgenol 147:149–154
Marlink RG, Lokich JJ, Robins JR, et al. (1990) Hepatic arterial embolization for metastatic hormone-secreting tumors. Technique, effectiveness, and complications. Cancer 65:2227–2232
Hajarizadeh H, Ivancev K, Mueller CR, et al. (1992) Effective palliative treatment of metastatic carcinoid tumors with intra-arterial chemotherapy/chemoembolization combined with octreotide acetate. Am J Surg 163:479–483
Ishikawa H, Kanai T, Ono T, et al. (1994) Analysis of cases with liver abscess following transcatheter arterial chemoembolization (TAE) for malignant hepatic tumors (Japanese). Gan To Kagaku Ryoho 21:2233–2236
Song SY, Chung JW, Han JK, et al. (2001) Liver abscess after transcatheter oily chemoembolization for hepatic tumors: incidence, predisposing factors, and clinical outcome. J Vasc Interv Radiol 12:313–320
Kim W, Clark TW, Baum RA, et al. (2001) Risk factors for liver abscess formation after hepatic chemoembolization J Vasc Interv Radiol 12:965–968
Geschwind JF, Kaushik S, Ramsey DE, et al. (2002) Influence of a new prophylactic antibiotic therapy on the incidence of liver abscesses after chemoembolization treatment of liver tumors. J Vasc Interv Radiol 13:1163–1166
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2006 Springer-Verlag Berlin Heidelberg
About this chapter
Cite this chapter
Tan, K.T., Kachura, J.R. (2006). Embolotherapy for Neuroendocrine Tumor Hepatic Metastases. In: Golzarian, J., Sun, S., Sharafuddin, M.J. (eds) Vascular Embolotherapy. Medical Radiology. Springer, Berlin, Heidelberg. https://doi.org/10.1007/3-540-33257-X_14
Download citation
DOI: https://doi.org/10.1007/3-540-33257-X_14
Publisher Name: Springer, Berlin, Heidelberg
Print ISBN: 978-3-540-21491-5
Online ISBN: 978-3-540-33257-2
eBook Packages: MedicineMedicine (R0)