Liver Transplantation for the Treatment of Liver Metastases From Neuroendocrine Tumors

Gedaly, Roberto; Daily, Michael F.; Davenport, Daniel L.; McHugh, Patrick P.; Koch, Alvaro; Angulo, Paul; Hundley, Jonathan C.

doi:10.1001/archsurg.2011.186

Cited by 172 publications

(130 citation statements)

References 16 publications

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“…In contrast to liver secondaries of adenocarcinomas, nonresectable neuroendocrine LM are an indication for LT under consideration of strict evaluation process (Lerut et al 2007, Bonaccorsi-Riani et al 2010, Gedaly et al 2011. 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.…”

Section: R170mentioning

confidence: 99%

Neuroendocrine tumor disease: an evolving landscape

Frilling

Åkerström

Falconi

et al. 2012

Endocrine-Related Cancer

143

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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Section: R170mentioning

confidence: 99%

Neuroendocrine tumor disease: an evolving landscape

Frilling

Åkerström

Falconi

et al. 2012

Endocrine-Related Cancer

143

106

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“…Other antitumor options, mainly transarterial liver chemoembolization, are frequently used with the expectation of combining antitumor and antisecretory early responses (5). Finally, beneficial effects with peptide receptor radionuclide therapy have been demonstrated in some patients with malignant insulinomas (37) as well as surgery including liver transplantation in anecdotal cases (5,31,37,38). Although sunitinib has recently been approved in progressive advanced pNET, the decline in blood glucose reported with this agent makes its use in malignant insulinoma questionable (37,39).…”

Section: Discussionmentioning

confidence: 99%

Efficacy of everolimus in patients with metastatic insulinoma and refractory hypoglycemia

Bernard

Lombard‐Bohas

Taquet

et al. 2013

European Journal of Endocrinology

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Background: Refractory hypoglycemia in patients with metastatic insulinoma is an important cause of morbidity and mortality. Everolimus could be a new therapeutic option. Methods: Within the French Group, we conducted a retrospective, multicentric study of endocrine tumors to evaluate the time to the first recurrence of symptomatic hypoglycemia, after everolimus initiation, in patients with metastatic insulinoma and refractory hypoglycemia. Ongoing hyperglycemic medical options, tumor response, and safety information were recorded. Results: Twelve patients with metastatic insulinoma and refractory hypoglycemia who were treated with everolimus between May 2007 and June 2011 were reviewed. Everolimus (starting dose, 10 mg/day, except in one patient, 5 mg/day) was given after a median of four previous therapeutic lines. Medication aimed at normalizing blood glucose levels in 11 patients. After a median duration of 6.5 months (range 1-35C months), median time to the first recurrence of symptomatic hypoglycemia was 6.5 months (range 0 to 35C months). Three patients discontinued everolimus because of cardiac and/or pulmonary adverse events at 1, 1.5, and 7 months after initiation, which led to two deaths. Three patients discontinued everolimus because of tumor progression at 2, 3, and 10 months after initiation, without recurrence of hypoglycemia. Conclusion: Everolimus appears to be a new effective treatment for patients with metastatic insulinoma and refractory hypoglycemia. Tolerance should be carefully monitored.

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“…However, recent clinical trials by the Mayo Clinic evaluating a multimodality treatment concept for CCA combining neoadjuvant radiochemotherapy and liver transplantation have established CCA as an indication for liver transplantation in selected patients with unresectable hilar CCA or CCA arising in patients with primary sclerosing cholangitis (Rosen et al 2010;Darwish Murad et al 2012). Clinical trials evaluating liver transplantation for selected patients with neuroendocrine hepatic metastases have shown long-term graft and patient survival comparable with patients transplanted for HCC (Gedaly et al 2011). In individual cases, patients with neuroendocrine liver metastases thus are eligible for liver transplantation.…”

Section: Indications For Liver Transplantationmentioning

confidence: 99%

Overview of the Indications and Contraindications for Liver Transplantation

Farkas

Hackl

Schlitt

2014

Cold Spring Harbor Perspectives in Medicine

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Liver transplantation is the only definitive treatment option for patients with irrevocable acute or chronic liver failure. In the last four decades, liver transplantation has developed from an experimental approach with a very high mortality to an almost routine procedure with good short-and long-term survival rates. Here, we present an up-to-date overview of the indications and contraindications for liver transplantation. It is shown how the evaluation of a candidate and finally listing for transplantation has to be performed in a multidisciplinary setting. Meticulous listing, timing, and organ allocation are the crucial factors to achieve an optimal outcome for the individual patient on the one hand, and reasonably using the limited deceased donor pool on the other hand. Living-donor liver transplantation is demanding but necessarily increasing. Because patients after liver transplantation need lifelong aftercare, it is important for primary care clinicians to understand the basic medical problems and risks.

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Liver Transplantation for the Treatment of Liver Metastases From Neuroendocrine Tumors

Abstract: To determine outcomes in patients undergoing liver transplantation (LT) for metastatic neuroendocrine tumors (NETs).

Cited by 172 publications

References 16 publications

Neuroendocrine tumor disease: an evolving landscape

Neuroendocrine tumor disease: an evolving landscape

Efficacy of everolimus in patients with metastatic insulinoma and refractory hypoglycemia

Overview of the Indications and Contraindications for Liver Transplantation

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