Liver metastases of neuroendocrine tumours; early reduction of tumour load to improve life expectancy
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Liver metastases of neuroendocrine tumours; early reduction of tumour load to improve life expectancy Liesbeth M Veenendaal1, Inne HM Borel Rinkes1, Cornelis JM Lips2 and Richard van Hillegersberg*1 Address: 1Department of Surgery, University Medical Center Utrecht, The Netherlands and 2Department of Clinical Endocrinology, University Medical Center Utrecht, The Netherlands Email: Liesbeth M Veenendaal - [email protected]; Inne HM Borel Rinkes - [email protected]; Cornelis JM Lips - [email protected]; Richard van Hillegersberg* - [email protected] * Corresponding author
Published: 26 June 2006 World Journal of Surgical Oncology 2006, 4:35
doi:10.1186/1477-7819-4-35
Received: 07 April 2006 Accepted: 26 June 2006
This article is available from: http://www.wjso.com/content/4/1/35 © 2006 Veenendaal et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract Background: Neuroendocrine tumours frequently metastasize to the liver. Although generally slowly progressing, hepatic metastases are the major cause of carcinoid syndrome and ultimately lead to liver dysfunction, cardiac insufficiency and finally death. Methods: A literature review was performed to define the optimal treatment strategy and workup in patients with neuroendocrine hepatic metastases. Based on this, an algorithm for the management of these patients was established. Results: Platelet serotonin and chromogranin A are useful biomarkers for detection and followup of neuroendocrine tumour. Helical computed tomography and somatostatin receptor scintigraphy are the most sensitive diagnostic modalities. Surgical debulking is an accepted approach for reducing hormonal symptoms and to establish better conditions for medical treatment, but is frequently impossible due to the extent of disease. A novel approach is the local ablation of tumour by thermal coagulation using therapies such as radiofrequency ablation (RFA) or laser induced thermotherapy (LITT). These techniques preserve normal liver tissue. There is a tendency to destroy metastases early in the course of disease, thereby postponing or eliminating the surgically untreatable stage. This can be combined with postoperative radioactive octreotide to eliminate small multiple metastases. In patients with extensive metastases who are not suitable for local destruction, systemic therapy by octreotide, 131I-MIBG treatment or targeted chemo- and radiotherapy should be attempted. A final option for selective patients is orthotopic liver transplantation. Conclusion: Treatment for patients with neuroendocrine hepatic metastases must be tailored for each individual patient. When local ablative therapies are used early in the course of the disease, the occurrence of carcinoid syndrome with end stage h
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