Metastatic neuroendocrine tumors of the gastrointestinal tract and pancreas: A surgeon's plea to centering attention on the liver

Semin Oncol. 2018 Aug;45(4):232-235. doi: 10.1053/j.seminoncol.2018.07.002. Epub 2018 Oct 11.

Abstract

Over 50% of patients with gastroenteropancreatic neuroendocrine tumors (GEP-NETs) have stage IV disease at presentation and the most likely organ to be affected by metastases is the liver. Hepatic involvement and hepatic tumor burden is a key prognostic factor affecting survival of these patients and 80% eventually die of liver failure due to tumor dissemination within the liver. This commentary explores the efficacy and limitations of systemic treatments in patients with GEP-NETs and liver metastases. Landmark randomized trials using systemic therapies including sandostatin (PROMID), lanreotide (CLARINET), everolimus (RADIANT 3 and 4), sunitinib and Peptide Receptor Radionuclide Therapy (NETTER-1) have not shown efficacy in reducing liver tumor burden in patients with stage IV GEP-NETs with liver metastases as outlined in this review. Although often overlooked, surgical debulking has been associated with a significant survival advantage in large retrospective studies and in our opinion should remain an important therapeutic option for patients with stage IV GEP-NETs and liver metastases.

Keywords: Liver metastases; Liver resection; Neuroendocrine tumor; Systemic therapy.

Publication types

  • Review

MeSH terms

  • Cytoreduction Surgical Procedures
  • Hepatectomy
  • Humans
  • Intestinal Neoplasms / pathology*
  • Intestinal Neoplasms / therapy*
  • Liver Neoplasms / secondary*
  • Liver Neoplasms / therapy*
  • Neuroendocrine Tumors / pathology*
  • Neuroendocrine Tumors / therapy*
  • Pancreatic Neoplasms / pathology*
  • Pancreatic Neoplasms / therapy*
  • Stomach Neoplasms / pathology*
  • Stomach Neoplasms / therapy*

Supplementary concepts

  • Gastro-enteropancreatic neuroendocrine tumor