Background: Liver metastases are a strong prognostic indicator in patients with gastro-entero-pancreatic neuroendocrine tumors (GEP-NETs). Therapeutic options for metastatic NETs are expanding and not mutually exclusive. Aims: This paper reviews the literature relating to multidisciplinary approach towards GEP-NET metastases, to highlight advances in knowledge regarding these tumors, and to understand the interdisciplinary management of individual patients. Methods: A PubMed search was performed for English-language publications from 1995 through 2012. Reference lists from studies selected were manually searched to identify further relevant reports. Manuscripts comparing different therapeutic options and advances for GEP-NET-related liver metastases were selected. Results: There is considerable controversy regarding the optimal management of GEP-NET metastases. Although radical surgery still remains the gold standard, a variety of other therapeutic options are available for metastatic GEP-NETs, including loco-regional chemotherapy/radiotherapy, radioembolization, systemic peptide receptor radionuclide therapy, biotherapy, and chemotherapy. In selected patients, liver transplantation should also be considered. Systemic somatostatin analogues and/or interferon show anti-proliferative effects, representing an appropriate first-line treatment for most patients. In advanced metastatic NETs, recent options include targeted therapies (i.e., everolimus and sunitinib). Conclusions: It is evident that multidisciplinary care and multimodality treatments remain the cornerstone of management of NET patients. Since NETs often show a more indolent behavior compared to other malignancies, physicians should aim to preserve a satisfactory quality of life for the patient by personalizing the therapeutic approach according to the tumor's features and prognostic factors. © 2012 The Society for Surgery of the Alimentary Tract.

Treatment of liver metastases in patients with digestive neuroendocrine tumors / R.E. Rossi, S. Massironi, M.P. Spampatti, D. Conte, C. Ciafardini, F. Cavalcoli, M. Peracchi. - In: JOURNAL OF GASTROINTESTINAL SURGERY. - ISSN 1091-255X. - 16:10(2012 Oct), pp. 1981-1992. [10.1007/s11605-012-1951-1]

Treatment of liver metastases in patients with digestive neuroendocrine tumors

R.E. Rossi
Primo
;
M.P. Spampatti;D. Conte;C. Ciafardini;F. Cavalcoli
Penultimo
;
M. Peracchi
Ultimo
2012

Abstract

Background: Liver metastases are a strong prognostic indicator in patients with gastro-entero-pancreatic neuroendocrine tumors (GEP-NETs). Therapeutic options for metastatic NETs are expanding and not mutually exclusive. Aims: This paper reviews the literature relating to multidisciplinary approach towards GEP-NET metastases, to highlight advances in knowledge regarding these tumors, and to understand the interdisciplinary management of individual patients. Methods: A PubMed search was performed for English-language publications from 1995 through 2012. Reference lists from studies selected were manually searched to identify further relevant reports. Manuscripts comparing different therapeutic options and advances for GEP-NET-related liver metastases were selected. Results: There is considerable controversy regarding the optimal management of GEP-NET metastases. Although radical surgery still remains the gold standard, a variety of other therapeutic options are available for metastatic GEP-NETs, including loco-regional chemotherapy/radiotherapy, radioembolization, systemic peptide receptor radionuclide therapy, biotherapy, and chemotherapy. In selected patients, liver transplantation should also be considered. Systemic somatostatin analogues and/or interferon show anti-proliferative effects, representing an appropriate first-line treatment for most patients. In advanced metastatic NETs, recent options include targeted therapies (i.e., everolimus and sunitinib). Conclusions: It is evident that multidisciplinary care and multimodality treatments remain the cornerstone of management of NET patients. Since NETs often show a more indolent behavior compared to other malignancies, physicians should aim to preserve a satisfactory quality of life for the patient by personalizing the therapeutic approach according to the tumor's features and prognostic factors. © 2012 The Society for Surgery of the Alimentary Tract.
gastro-entero-pancreatic neuroendocrine tumors (GEP-NETs); liver metastases; liver-directed therapies; somatostatin analogues; ablation techniques; antineoplastic agents; antineoplastic combined chemotherapy protocols; combined modality therapy; digestive system neoplasms; embolization, therapeutic; hepatectomy; humans; liver neoplasms; liver transplantation; neuroendocrine tumors; radiotherapy; treatment outcome; surgery; gastroenterology
Settore MED/12 - Gastroenterologia
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2434/252531
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