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New Approaches: Combined Local and Multimodal Strategies in the Treatment of Complex Neuroendocrine Liver Metastases

  • Alexander Petrovitch
  • Merten Hommann
  • Dieter Hörsch
  • Patricia Grau
  • Sándor Kónya
  • Arnold Schneider
  • Richard P. Baum
Chapter
Part of the Medical Radiology book series (MEDRAD)

Abstract

Neuroendocrine tumors differ with regard to their biological behavior from tumor of epithelial origin. From one side this leads to a better 5-year-survival rate, while from the other side most of the patients will develop liver metastases during the long course of disease. Metastatic diseases could be divided into two groups: hormonally active and hormonally inactive tumors—up to 60 % of patients with liver metastases will develop such a hormonally driven carcinoid syndrome. Involvement of the liver is the most important factor for overall survival and also quality of life. Until now the golden standard for the treatment of liver metastases has been curative resection. Unfortunately only 10–20 % of the cases have a resectable disease. As an alternative way of treatment, interventions on the liver are more and more an integral part of new multimodal therapy concepts and can be combined safely with systemic treatments and also combined together. Proven combinations are TACE (transarterial chemoembolization) plus SIRT (selective internal radiotherapy), TACE plus PRRT, and also SIRT and PRRT could be combined safely. In most of these cases spreading or diameter of the metastases will not allow a thermal treatment, so the interventional treatment concepts are dominated presently by embolizing procedures. They allow to treat a larger number of liver lesions during a long course of disease. Mainly in cases with combined treatment with embolization procedures or in cases with a huge tumor-load, a critical work-up of liver vascularization has to be done before. Otherwise and also in the case of overtreatment, the risk of severe biliary complications, followed by liver failure will be high.

Keywords

Liver Metastasis Portal Vein Embolization Transarterial Chemoembolization Cystic Artery Embolization Procedure 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Alexander Petrovitch
    • 1
  • Merten Hommann
    • 2
  • Dieter Hörsch
    • 3
  • Patricia Grau
    • 1
  • Sándor Kónya
    • 1
  • Arnold Schneider
    • 1
  • Richard P. Baum
    • 4
  1. 1.Institute for Interventional Radiology and Neuroradiology Central ClinicsENETS Center of ExcellenceBad BerkaGermany
  2. 2.Clinics for Surgery and Visceral surgery Central ClinicsENETS Center of ExcellenceBad BerkaGermany
  3. 3.Clinics for Gastroenterology Central ClinicsENETS Center of ExcellenceBad BerkaGermany
  4. 4.Institute and Clinics for Nuclear Medicine Central ClinicsENETS Center of ExcellenceBad BerkaGermany

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