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Published on: May 8, 2018
Treatment strategies for neuroendocrine liver metastases: a systematic review
Edoardo M Muttillo1, Gennaro Mazzarella2, Biagio Picardi2
1Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy; Research Institute Against Digestive Cancer (IRCAD), Strasbourg, France.
Background:
Gastroenteropancreatic neuroendocrine tumors are often diagnosed when metastatic. The liver is the main site of metastases. Unfortunately, optimal management of neuroendocrine liver metastases remains a topic of debate. The aim of this study was to make a systematic review of the current literature about the results of the different treatments of neuroendocrine liver metastases.
Methods:
A systematic review was conducted for English language publications from 1995 to 2021. Outcomes were analyzed according to survival, disease-free survival, and in the case of systemic therapies, progression-free survival.
Results:
5509 patients were analyzed in the review. 67% of patients underwent surgery achieving 5 years overall survival despite only 30% percent without a recurrence. 60% of patients that had received a transplant reached 5 years survival with a low disease-free survival rate (20%). Five-year survival rate was 36.2% for patients undergoing loco-regional therapies.
Conclusion:
Surgical resection is the best treatment when metastases are resectable, with the highest rate of survival, although liver transplantation shows good results for patients not eligible for surgery. Loco-regional therapies may be useful when surgical resection is contraindicated, or selectively used as a bridge to surgery or transplantation. Systemic therapies are indicated in patients for whom curative treatment cannot be obtained.
Insights
Surgical resection offers the best survival for resectable neuroendocrine liver metastases. Liver transplantation and loco-regional therapies provide alternatives for non-resectable cases, while systemic therapies manage advanced disease.
Area of Science:
- Oncology
- Hepatology
- Gastroenterology
Background:
- Neuroendocrine tumors frequently metastasize to the liver, posing management challenges.
- Optimal treatment strategies for neuroendocrine liver metastases (NELM) are debated.
- This study systematically reviews current literature on NELM treatment outcomes.
Approach:
- A systematic review of English-language publications from 1995 to 2021.
- Analysis of outcomes including overall survival, disease-free survival, and progression-free survival.
- Inclusion of data from 5509 patients with NELM.
Key Points:
- Surgical resection achieved 5-year survival in 67% of patients, but recurrence was common (70%).
- Liver transplantation resulted in 5-year survival for 60% of patients, with a 20% disease-free survival rate.
- Loco-regional therapies offered a 5-year survival rate of 36.2%.
Conclusions:
- Surgical resection is the preferred treatment for resectable NELM due to superior survival rates.
- Liver transplantation is a viable option for patients ineligible for surgery.
- Loco-regional therapies serve as alternatives or bridges to surgery/transplantation, and systemic therapies are for unresectable or advanced disease.
