Treatment options for PNET liver metastases: a systematic review

Abstract

BackgroundPancreatic neuroendocrine tumors (PNETs) are rare pancreatic neoplasms. About 40–80% of patients with PNET are metastatic at presentation, usually involving the liver (40–93%). Liver metastasis represents the most significant prognostic factor. The aim of this study is to present an up-to-date review of treatment options for patients with liver metastases from PNETs.MethodsA systematic literature search was performed using the PubMed database to identify all pertinent studies published up to May 2018.ResultsThe literature search evaluated all the therapeutic options for patients with liver metastases of PNETs, including surgical treatment, loco-regional therapies, and pharmacological treatment. All the different treatment options showed particular indications in different presentations of liver metastases of PNET. Surgery remains the only potentially curative therapeutic option in patients with PNETs and resectable liver metastases, even if relapse rates are high. Efficacy of medical treatment has increased with advances in targeted therapies, such as everolimus and sunitinib, and the introduction of radiolabeled somatostatin analogs. Several techniques for loco-regional control of metastases are available, including chemo- or radioembolization.ConclusionsTreatment of patients with PNET metastases should be multidisciplinary and must be personalized according to the features of individual patients and tumors.

Evaluation of Outcomes Following Surgery for Locally Advanced Pancreatic Neuroendocrine Tumors

“…To our knowledge, this study is unique in its evaluation of patients with locally advanced PNETs without distant metastatic disease. Most other publications have focused on either resection of liver or distant metastases to determine whether resection improves survival for those patients 8 , 9 , 10 , 11 , 12 , 13 , 14 or on the resection of tumors less than 2 cm (T1/T2 tumors), 20 but this study focused on large, locally advanced tumors. In patients with locally advanced disease, aggressive surgical excision of tumor remains controversial.…”

“…The outcome of surgery for liver metastases from PNETs has been extensively studied previously. 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 However, little is known about surgery for locally advanced PNETs without liver (or other distant) metastases 16 because it has not, to our knowledge, been previously addressed, likely secondary to the rarity of this presentation. It is important because major surgery to resect locally advanced, possibly nodal metastatic PNETs may be morbid and have life-threatening complications.…”

Pancreatic neuroendocrine tumors: Therapeutic challenges and research limitations

“…Systemic therapeutic decisions for the management of PNETs must be personalized and rely on various considerations including functional imaging and molecular profiling in addition to clinical considerations such as hormonal secretion, tumor grade, disease burden, and the rate at which tumor progresses[ 29 ]. These considerations predict whether systemic or locoregional treatment will benefit patients[ 30 ]. The impact of therapies on the quality of the life of the patient must be considered prior to making any therapeutic decision.…”

Metastasis in Pancreatic Ductal Adenocarcinoma: Current Standing and Methodologies

“…While 40%-80% of patients with PNET are metastatic at presentation, usually involving the liver (40%-93%) [3], treatment options do exist and include locoregional therapy, chemotherapy, as well as liver transplant [4]. A detailed review on the metastasis of PNET can be found in [5]. Herein, we will focus on the metastasis of PDA.…”