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Management of Advanced Neuroendocrine Tumors With Hepatic Metastasis

Khasraw, Mustafa MRCP*; Gill, Anthony FRCPA; Harrington, Tim FRACR; Pavlakis, Nick PhD, FRACP*; Modlin, Irvin PhD, FRCS§

Journal of Clinical Gastroenterology: October 2009 - Volume 43 - Issue 9 - p 838-847
doi: 10.1097/MCG.0b013e3181b152a1

Neuroendocrine tumors (NETs) in general and specifically these gastroenteropancreatic-neuroendocrine tumors often present a considerable diagnostic and therapeutic challenge, especially those that behave in an aggressive fashion. The majority of tumors are diagnosed at a stage that the only curative treatment, radical surgical intervention, is no longer an option and thus long-term therapy with somatostatin analogs is focused on symptom amelioration and in the improvement of quality of life. Although biotherapy is currently the most efficient treatment to achieve palliation, conventional chemotherapy may have some utility in undifferentiated or highly proliferating neuroendocrine carcinomas and pancreatic NETs. Hepatic metastases, depending on size, location, and number may be amenable to surgical resection or radiofrequency ablation. If surgery is not feasible, embolization either alone (bland), in combination with chemotherapeutic agents, or using radioactive microspheres can be used. Peptide receptor targeted radiotherapy using radiolabeled octapeptide analogs (90Yttrium or 177Lutetium-octreotide) may lead to reduction in tumor size, but in most circumstances has a tumor stabilizing effect. A variety of antiangiogenesis and growth factor-targeted agents have been evaluated, but to date, the results have failed to meet our expectations.

Departments of *Medical Oncology

Anatomical Pathology

Radiology, Royal North Shore Hospital, Sydney, St Leonards NSW, Australia

§Yale University School of Medicine, New Haven, CT

Funding Declaration Statement/Disclosure Statement: No grants or financial support has been received in relation to this manuscript.

Reprints: Mustafa Khasraw, MRCP, Department of Medical Oncology, Royal North Shore Hospital, St Leonards NSW 2065, Australia (e-mail:

Irvin Modlin has lectured for Novartis and Tercica. Nick Pavlakis has lectured for Novartis and Roche and has been on the advisory board of Novartis and Roche. The other authors have no conflict of interest to declare and nothing to disclose.

© 2009 Lippincott Williams & Wilkins, Inc.