Management of neuroendocrine liver metastases

The optimum management of neuroendocrine liver metastases, particularly the role of liver transplantation is ill-defined. Current strategies are based on anecdotal reports and small retrospective studies, rather than prospective data. This, as well as the failure to standardize treatment, has probably contributed to the reported variations in outcome.

To formulate a putative management protocol and to reevaluate the role of liver transplantation in patients with neuroendocrine liver metastases, a review of the published literature (Medline search) was conducted.

Isolated hepatic metastases should be resected when suitable. Chemoembolization of liver metastases should precede resection of bulky disease and be used to palliate those with unresectable disease. Radiofrequency ablation is suitable for smaller metastatic lesions (<3 cm diameter) in the liver. Systemic treatment with somatostatin analogues or radioactive metaiodobenzylguanidine (MIBG) is appropriate to reduce symptoms and slow disease progression, but prospective data is required to define their exact roles as adjuvant and therapeutic agents. Although current systemic chemotherapy, applied in isolation, may have a role in patients in whom other therapies have failed, its efficacy remains unproven. Restriction of liver transplantation to the treatment of patients with carcinoid metastases with biologically favorable features, limited tumor bulk and without systemic disease may make transplantation a curative rather than a palliative treatment option in selected patients.