Is there still a role for the hepatic locoregional treatment of metastatic neuroendocrine tumors in the era of systemic targeted therapies?

Abstract

Gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs) frequently present with distant metastases at the time of diagnosis and the liver is the most frequent site of spreading. The early identification of metastatic disease represents a major prognostic factor for GEP-NENs patients. Radical surgical resection, which is feasible for a minority of patients, is considered the only curative option, while the best management for patients with unresectable liver metastases is still being debated. In the last few years, a number of locoregional and systemic treatments has become available for GEP-NEN patients metastatic to the liver. However, to date only a few prospective studies have compared those therapies and the optimal management option is based on clinical judgement. Additionally, locoregional treatments appear feasible and safe for disease control for patients with limited liver involvement and effective in symptoms control for patients with diffuse liver metastases. Considering the lack of randomized controlled trials comparing the locoregional treatments of liver metastatic NEN patients, clinical judgment remains key to set the most appropriate therapeutic pathway. Prospective data may ultimately lead to more personalized and optimized treatments. The present review analyzes all the locoregional therapy modalities (i.e., surgery, ablative treatments and transarterial approach) and aims to provide clinicians with a useful algorithm to best treat GEP-NEN patients metastatic to the liver.

Clinicopathological Characteristics of the primary and metastatic Hepatic Neuroendocrine Tumors and the relevant Prognosis-Related Factors: A Retrospective Study of 81 Cases in a Single Chinese Center

“…In our study, the curative effect of LAR and chemotherapy in both PHNETs and metastatic HNETs patients were not specifically evaluated in 81 cases mainly owing to the delayed publication of the above treatment method which makes some of the enrolled patients no objective conditions for accepting LAR or other therapeutic methods, however, the clinical correlation between treatment modalities and survival were explored, we found that, in respect to OS, there was a statistical significance between local/combined treatment modalities and systematic treatment, which indicated that patients who underwent local treatment modality can achieve a better prognosis. Our findings were rightly consistent with the recent analysis 23 .…”

Possibilities of treating patients with generalized neuroendocrine tumors

“…Комплексное лечение генерализованных НЭО является единственной возможностью оказать реальное влияние на течение заболевания, увеличив продолжительность и качество жизни пациентов, о чем свидетельствуют результаты исследований разных авторов [31]. Так, K. Oberg и соавт.…”

Liver-directed therapies for liver metastases from neuroendocrine neoplasms: Can laser ablation play any role?

“…Therefore, it requires a tailored approach that should be shared by a multidisciplinary team including at least medical and radiation oncologists, surgeon, pathologist, endocrinologist, and interventional radiologist. The primary treatment goal should be curative, and radical surgical resection is considered the only curative option, but it can be offered to a minority of patients[ 7 , 11 - 13 ]. Indeed, LM are often present at diagnosis, or occur during the disease, also in slow-growing tumors[ 8 ].…”