Indications and Results of Liver Transplantation in Patients with Neuroendocrine Tumors

Olausson, Michael; Friman, Styrbjörn; Cahlin, Christian; Nilsson, Ola; Jansson, Svante; Wängberg, Bo; Ahlman, Håkan

doi:10.1007/s00268-002-6631-y

Cited by 85 publications

(56 citation statements)

References 22 publications

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“…Although performed in a minority of patients, liver transplantation in NET patients with hepatic secondary lesions has been reported to ensure good palliation in highly selected patients: symptomatic patients refractory to systemic medical treatment or unsuitable for interventional procedures and those with a progressive hepatic tumor load (28,29). In patients not meeting these criteria, the risks of surgery-related morbidity and mortality, tumor progression, and immunosuppressive treatment might favor a conservative approach.…”

Section: Discussionmentioning

confidence: 99%

⁶⁸Ga-DOTANOC PET/CT Clinical Impact in Patients with Neuroendocrine Tumors

Ambrosini¹,

Campana²,

Bodei³

et al. 2010

J Nucl Med

218

124

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Several authors reported the superiority of 68 Ga-DOTANOC PET/ CT to conventional imaging (CI) for the assessment of neuroendocrine tumors (NET). However, the detection of a higher number of lesions is not necessarily followed by a modification of disease stage or therapeutic approach. The aim of this study was to assess the impact of 68 Ga-DOTANOC PET/CT on the clinical management of NET patients. Methods: The study included 90 patients with pathologic confirmation of NET, CT performed within a month of 68 Ga-DOTANOC PET/CT, and a follow-up period of at least 1 y. PET/CT results were compared with CI results. As a standard of reference to finally evaluate PET results, clinical and imaging follow-up data were used. To assess the clinical impact of PET findings, all referring physicians were contacted after PET and asked about how patients were managed. Stage or therapy modifications were independently recorded, and the overall impact was evaluated patient by patient if PET results either affected therapy or caused a change in disease stage. Results: Considering PET/CT and CI concordant cases (47/90 [52.2%]), PET findings affected the therapeutic management in 17 of 47 (36.2%) patients. Although PET did not result in modification of disease stage, 68 Ga-DOTANOC detected a higher lesion number in most patients. PET/CT and CI findings were discordant in 42 of 90 (46.7%) patients: PET resulted in a modification of stage in 12 patients (28.6%) and affected the treatment plan in 32 patients (76.2%). PET and CT were both equivocal in 1 patient (1/90). Considering all cases, 68 Ga-DOTANOC PET/CT affected either stage or therapy in 50 of 90 (55.5%) patients. The most frequent impact on management (27 patients) was the initiation or continuance of peptide receptor radionuclide therapy, followed by the initiation or continuance of somatostatin analog medical treatment (7 patients) and referral to surgery (6 patients). PET prevented unnecessary surgery in 6 patients and excluded from treatment with somatostatin analogs 2 patients with NET lesions that did not express somatostatin receptors. Less frequent impacts on management included the initiation of radiotherapy (1 patient), further diagnostic investigation (1 patient), and liver transplantation (1 patient). Conclusion: 68 Ga-DOTANOC PET/CT either affected stage or caused a therapy modification in more than half the patients, thus confirming the clinical role of PET in the management of NET.

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Section: Discussionmentioning

confidence: 99%

⁶⁸Ga-DOTANOC PET/CT Clinical Impact in Patients with Neuroendocrine Tumors

Ambrosini¹,

Campana²,

Bodei³

et al. 2010

J Nucl Med

218

124

View full text Add to dashboard Cite

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“…While nonresectable extrahepatic tumor manifestation, Ki-67% O15%, and severe carcinoid heart disease are generally accepted as exclusion criteria for LT, patient age (!50 vs O50 years), the dynamics of the hepatic tumor growth (stable disease vs rapid tumor progress), the extent of hepatic involvement, and timing of transplantation (first-line treatment vs an ultima ratio approach after unsuccessful previous treatment) remain controversial (Olausson et al 2002, Rosenau et al 2002, Le Treut et al 2008. Although encouraging overall 5-year survival rates of 50-90% have been reported in newer series, disease recurrence within 2-3 years after LT is to be expected (Frilling et al 2006, van Vilsteren et al 2006, Olausson et al 2007.…”

Section: R170mentioning

confidence: 99%

Neuroendocrine tumor disease: an evolving landscape

Frilling

Åkerström

Falconi

et al. 2012

Endocrine-Related Cancer

148

106

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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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“…Most transplanted patients have recurrences within months to years, possibly due to postoperative immunosuppressive treatment and/or undiagnosed extrahepatic metastases prior to the procedure. Hence, improved methods for the detection of extrahepatic metastases are necessary before liver transplantation can be used or recommended [135,136,137,138,139,140,141,142,143,144,145,146]. …”

Section: Liver Transplantationmentioning

confidence: 99%