Consensus Guidelines for the Management of Patients with Liver Metastases from Digestive (Neuro)endocrine Tumors: Foregut, Midgut, Hindgut, and Unknown Primary

Steinmüller, Thomas; Kianmanesh, Réza; Falconi, Massimo; Scarpa, Aldo; Taal, Babs G.; Kwekkeboom, Dik J.; Lopes, José Manuel; Perren, Aurel; Nikou, George C.; Yao, James C.; Fave, G. F. Delle; O’Toole, Dermot

doi:10.1159/000111037

Cited by 278 publications

(232 citation statements)

References 108 publications

(141 reference statements)

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“…ENETS guidelines identified some essential prerequisites before performing surgery in patients with LM from digestive NETs (48). These criteria include: i) the presence of well-differentiated lesions (Ki67 !5%); ii) the absence of right heart insufficiency; iii) the absence of extra-abdominal disease; and iv) the absence of diffuse peritoneal carcinomatosis (48). Under these circumstances, we recognize two different phases in the management of these patients, which are the primary tumor resection and the surgical treatment of liver lesions.…”

Section: Surgery Of Advanced Netsmentioning

confidence: 99%

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GEP–NETS UPDATE: A review on surgery of gastro-entero-pancreatic neuroendocrine tumors

Partelli

Maurizi

Tamburrino

et al. 2014

European Journal of Endocrinology

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The incidence of neuroendocrine tumors (NETs) has increased in the last decades. Surgical treatment encompasses a panel of approaches ranging from conservative procedures to extended surgical resection. Tumor size and localization usually represent the main drivers in the choice of the most appropriate surgical resection. In the presence of small (!2 cm) and asymptomatic nonfunctioning NETs, a conservative treatment is usually recommended. For localized NETs measuring above 2 cm, surgical resection represents the cornerstone in the management of these tumors. As they are relatively biologically indolent, an extended resection is often justified also in the presence of advanced NETs. Surgical options for NET liver metastases range from limited resection up to liver transplantation. Surgical choices for metastatic NETs need to consider the extent of disease, the grade of tumor, and the presence of extra-abdominal disease. Any surgical procedures should always be balanced with the benefit of survival or relieving symptoms and patients' comorbidities.

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Section: Surgery Of Advanced Netsmentioning

confidence: 99%

“…Curative resection (R0/R1) is associated with a better long-term survival in all series and survival rates of 60-80% can be achieved (48). However, the overall survival after hepatic resection has been reported in 46-86% at 5 years and 35-79% at 10 years (49,59,60,61,62,63,64,65,66,67,68,69,70,71,72).…”

Section: Surgery Of Lmmentioning

confidence: 99%

GEP–NETS UPDATE: A review on surgery of gastro-entero-pancreatic neuroendocrine tumors

Partelli

Maurizi

Tamburrino

et al. 2014

European Journal of Endocrinology

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“…Unfortunately, given the late stage presentation and the high incidence of multifocal and bilobar deposits, radical liver resection is possible in !20% of patients (Steinmuller et al 2008). In order to facilitate better patient selection for treatment, a classification system for neuroendocrine LM based on morphological extent of hepatic involvement has been proposed: type I, a single metastasis of any size; type II, an isolated metastatic bulk accompanied by smaller deposits, with both liver lobes always involved, and type III, disseminated metastatic spread, with both liver lobes always involved, with single lesions of varying size and virtually no normal liver parenchyma (Frilling et al 2009).…”

Section: R170mentioning

confidence: 99%

Neuroendocrine tumor disease: an evolving landscape

Frilling

Åkerström

Falconi

et al. 2012

Endocrine-Related Cancer

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Gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs) represent a heterogenous group of tumors arising from a variety of neuroendocrine cell types. The incidence and prevalence of GEPNENs have markedly increased over the last three decades. Symptoms are often absent in early disease, or vague and nonspecific even in advanced disease. Delayed diagnosis is thus common. Chromogranin A is the most commonly used biomarker but has limitations as does the proliferative marker Ki-67%, which is often used for tumor grading and determination of therapy. The development of a multidimensional prognostic nomogram may be valuable in predicting tumor behavior and guiding therapy but requires validation. Identification of NENs that express somatostatin receptors (SSTR) allows for SSTR scintigraphy and positron emission tomography imaging using novel radiolabeled compounds. Complete surgical resection of limited disease or endoscopic ablation of small lesions localized in stomach or rectum can provide cure; however, the majority of GEP-NENs are metastatic (most frequently the liver and/or mesenteric lymph nodes) at diagnosis. Selected patients with metastatic disease may benefit from advanced surgical techniques including hepatic resection or liver transplantation. Somatostatin analogs are effective for symptomatic treatment and exhibit some degree of antiproliferative activity in small intestinal NENs. There is a place for streptozotocin, temozolomide, and capecitabine in the management of pancreatic NENs, while new agents targeting either mTOR (everolimus) or angiogenic (sunitinib) pathways have shown efficacy in these lesions.

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“…Th ere are several small series testing capecitabine and temozolomide with response rates in the 40% to 70% range. Palliation of unresectable tumors may be achieved with hepatic arterial embolization with improvement in symptoms and reduction in overall tumor burden (4). Unfortunately in our patient, hypercortisolemia persisted despite available medical and surgical interventions.…”

Section: Discussionmentioning

confidence: 77%

Metastatic Pancreatic Neuroendocrine Tumor with Ectopic Adrenocorticotropic Hormone Production

Vaduganathan

Nagarur

Kerr

et al. 2015

Baylor University Medical Center Proceedings

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Consensus Guidelines for the Management of Patients with Liver Metastases from Digestive (Neuro)endocrine Tumors: Foregut, Midgut, Hindgut, and Unknown Primary

Cited by 278 publications

References 108 publications

GEP–NETS UPDATE: A review on surgery of gastro-entero-pancreatic neuroendocrine tumors

GEP–NETS UPDATE: A review on surgery of gastro-entero-pancreatic neuroendocrine tumors

Neuroendocrine tumor disease: an evolving landscape

Metastatic Pancreatic Neuroendocrine Tumor with Ectopic Adrenocorticotropic Hormone Production

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