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Multimodal liver-directed management of neuroendocrine hepatic metastases
1Division of Medical Oncology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
Abstract:
A preponderance of patients with neuroendocrine tumors (NETs) will experience hepatic metastases during the course of their disease. Many diagnoses of NETs are made only after the neoplasms have spread from their primary gastroenteropancreatic sites to the liver. This paper reviews current evidence-based treatments for neuroendocrine hepatic metastases, encompassing surgery, hepatic artery embolization (HAE) and chemoembolization (HACE), radioembolization, hepatic artery infusion (HAI), thermal ablation (radiofrequency, microwave, and cryoablation), alcohol ablation, and liver transplantation as therapeutic modalities. Consideration of a multidisciplinary approach to liver-directed therapy is strongly encouraged to limit morbidity and mortality in this patient population.
Insights
Neuroendocrine tumors (NETs) frequently spread to the liver. This review covers evidence-based treatments for neuroendocrine hepatic metastases, including surgery, ablation, and transplantation, emphasizing a multidisciplinary approach.
Area of Science:
- Oncology
- Hepatology
- Gastroenterology
Background:
- Neuroendocrine tumors (NETs) commonly metastasize to the liver.
- Diagnosis is often delayed until after hepatic spread from primary gastroenteropancreatic sites.
- Hepatic metastases significantly impact patient morbidity and mortality.
Purpose of the Study:
- To review current evidence-based treatments for neuroendocrine hepatic metastases.
- To provide a comprehensive overview of available liver-directed therapies.
- To emphasize the importance of a multidisciplinary approach.
Main Methods:
- Literature review of evidence-based treatments for neuroendocrine hepatic metastases.
- Synthesis of data on surgical, interventional, and ablative therapies.
- Analysis of liver transplantation as a therapeutic option.
Main Results:
- Multiple therapeutic modalities exist for neuroendocrine hepatic metastases.
- Treatments include surgery, hepatic artery embolization (HAE), chemoembolization (HACE), radioembolization, hepatic artery infusion (HAI), thermal ablation, alcohol ablation, and liver transplantation.
- A multidisciplinary approach is crucial for optimal patient outcomes.
Conclusions:
- Effective management of neuroendocrine hepatic metastases requires a tailored, multidisciplinary strategy.
- Selection of therapy should be individualized based on tumor burden, patient factors, and treatment goals.
- Integrated care pathways can improve survival and quality of life for patients with NETs and liver metastases.
