Abstract
Neuroendocrine tumors differ with regard to their biological behavior from tumor of epithelial origin. From one side this leads to a better 5-year-survival rate, while from the other side most of the patients will develop liver metastases during the long course of disease. Metastatic diseases could be divided into two groups: hormonally active and hormonally inactive tumors—up to 60 % of patients with liver metastases will develop such a hormonally driven carcinoid syndrome. Involvement of the liver is the most important factor for overall survival and also quality of life. Until now the golden standard for the treatment of liver metastases has been curative resection. Unfortunately only 10–20 % of the cases have a resectable disease. As an alternative way of treatment, interventions on the liver are more and more an integral part of new multimodal therapy concepts and can be combined safely with systemic treatments and also combined together. Proven combinations are TACE (transarterial chemoembolization) plus SIRT (selective internal radiotherapy), TACE plus PRRT, and also SIRT and PRRT could be combined safely. In most of these cases spreading or diameter of the metastases will not allow a thermal treatment, so the interventional treatment concepts are dominated presently by embolizing procedures. They allow to treat a larger number of liver lesions during a long course of disease. Mainly in cases with combined treatment with embolization procedures or in cases with a huge tumor-load, a critical work-up of liver vascularization has to be done before. Otherwise and also in the case of overtreatment, the risk of severe biliary complications, followed by liver failure will be high.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Ackermann NB, Lien WM (1970) The blood supply of experimental liver metastases I: the distribution of hepatic artery and portal vein blood to “small” and “large” tumors. Surgery 66(6):1067–1072
Ahlmann H, Frimann S, Cahlin C et al (2004) Liver transplantation for treatment of metastatic neuroendocrine tumors. Ann NY Acad Sci 1014:265–269
Auernhammer CJ, Jauch KW, Hoffmann JN (2009) Liver metastases from neuroendocrine tumours of the gastroenteropancreatic system—therapeutic strategies. Zentralbl Chir 134:410–417
Bax NDS, Woods HF, Batchelor A, Jennings M (1996) Clinical manifestations of carcinoid disease. World J Surg 20(2):142–146
Bechstein WO, Neuhaus P (1994) Liver transplantation for hepatic metastases of neuroendocrine tumors. Ann NY Acad Sci 733:507–514
Blonski WC, Reddy KR, Shaked A et al (2005) Liver transplantation for metastatic neuroendocrine tumour: a case report and review of literature. World J Gastroenterol 11:7676–7683
Boudreaux JP, Putty B, Frey DJ et al (2005) Surgical treatment and state of advanced stage carcinoid tumors: lessons learned. Ann Surg 241:838–845
Breedis C, Young G (1954) The blood supply of neoplasm in the liver. Am J Pathol 30:969–984
Brown KT, Koh YJ, Brody LA, Getrajdman LI, Susman J, Fong Y, Blumgart LH (1999) Particle embolization of hepatic neuroendocrine metastases for control of pain and hormonal symptoms. JVIR 10:397–403
Chamberlain RS, Canes D, Brown KT et al (2000) Hepatic neuroendocrine tumour metastases: does intervention alter outcomes? J Am Coll Surg 190:432–445
Coppa J, Pulvirenti A, Schiavo M et al (2001) Resection versus transplantation for liver metastases from neuroendocrine tumours. Transpl Proc 33:1537–1539
de Baere T, Deschamps F, Teriitheau C, Rao P, Conengrapht K, Schlumberger M, Lebouelleux S, Baudin E, Hechelhammer L (2008) Transarterial chemoembolization of liver metastases from well differentiated gastroenteropancreatic endocrine tumors with doxorubicine eluting beads: preliminary results. JVIR 19:855–861
Ganguli S, Goldberg SN (2009) Radiofrequency equipment an scientific basis for radiofrequency ablation. In : Adam A, Mueller P (eds) Interventional radiological treatment of liver tumors. Cambridge University Press, New York, pp 167–180
Gaur SK, Friese JL, Sadow CA, Ayyagari R, Binkert CA, Schenkert MP, Kulke M, Baum R (2011) Hepatic arterial chemoembolization using drug-eluting beads in gastrointestinal neuroendocrine tumor metastatic to the liver. Cardiavasc Intervent Radiol 34:566–572
Hörsch D Bert T, Schrader J, Hommann M, Kaemmerer D, Petrovitch A, Zaknun J, Baum RP (2012) Pancreatic neuroendocrine neoplasms. Minerva Gastroenterol Dietol 58:401–426
Jensen RT (1999) Natural history of digestive endocrine tumors. In: Mignon M, Colombel JF (eds) Recent advances in the pathophysiology and management of inflammatory bowel disease and digestive endocrine tumors. John Libbey Eurotext, Paris, pp 192–219
Kennedy A, Nag S, Salem R, Murthy R, Mc Ewan AJ, Nutting C, Benson A 3rd, Espat J, Bilbao JI, Sharma RA, Thomas JP, Coldwell D (2007) Recommendations for radioembolisation of hepatic malignancies using Yttrium-90 microsphere brachytherapy: a consensus panel report from the radioembolization brachytherapy oncology consortium. Int J Radiat Oncol Biol Phys 68:13–23
Kennedy A S, Dezarn WA, McNeillie P, Coldwell D, Nutting C, Carter D, Murthy R, Rose MD, Warner RRP, Liu D, Palmedo H, Overton C, Jones B, Salem R (2008) Radioembolization for unresectable neuroendocrine hepatic metastases using resin 90Y-microspheres: early results in 148 patients. Am J Clin Oncol 31(3):271–279
Knox CD, Anderson CD, Lamps LW et al (2003) Long time survival after resection of primary hepatic carcinoid tumour. Ann Surg Oncol 10:1171–1175
Lippert H, Pabst R (1985) Arterial variations in man—classification and frequency. Bergmann, München, pp 13–47
Marrache F, Vullierme MP, Roy C, El Assoued Y, Couvelard A, O’Toole D, Mitry E, Hentic O, Hammel P, Lévy P, Ravaud P, Rougier P, Ruszniewski P (2007) Arterial phase enhancement and body mass index are predictors of response to chemoembolisation for liver metastases of endocrine tumours. Br J Cancer 96:49–55
Michels N (1955) Blood supply and anatomy of the upper abdominal origins with a descriptive atlas. Lippincott, Philadelphia, pp 147–148
Northover JMA, Terblanche J (1979) A new look at the arterial supply of the bile duct in man and its surgical implications. Br J Surg 66:379–384
Pennes HH (1948) Analysis of tissue and arterial blood temperatures in the resting human forearm. J Appl Physiol 1:93–122
Pitt SC, Knuth J, Keily JM, McDermott JC, Weber SM, Chen H, Rilling WS, Quebbeman EJ, Agarwal DM, Pitt HA (2008) Hepatic neuroendocrine metastases: chemo- or bland embolization? J Gastrointest Surg 12:1951–1960
Proye C (2001) Natural history of liver metastasis of gastroenteropancreatic neuroendocrine tumors: place for chemoembolization. World J Surg 25:685–688
Redman HC, Reuter SR (1970) Arterial collaterals in the liver hilus. Radiology 94(3):575–579
Roche A, Girish BV, de Baère T, Baudin E, Boige V, Elias D, Lasser P, Schlumberger M, Ducreux M (2003) Trans catheter arterial chemoembolization as first-line treatment for hepatic metastases from endocrine tumors. Eur Radiol 13:136–140
Sarmiento JM, Heywood G, Rubin J, Ilstrup DM, Nagorney DM Que FG (2003) Surgical treatment of neuroendocrine tumor metastases to the liver: a plea for resection to increase survival. J Am Coll Surg 197:29–37
Strosberg JR, Choi J, Cantor AB, Kvols LK (2006) Selective hepatic artery embolization for treatment of patients with metastatic carcinoid and pancreatic neuroendocrine tumors. Cancer Control 13:72–78
Tohma T, Cho A, Okazumi S et al (2005) Communication arcade between the right and left hepatic arteries: evaluation with CT and angiography during temporary balloon occlusion of the right or left hepatic artery. Radiology 237(1):361–365
Uflacker R (2007) Atlas of vascular anatomy—an angiographic approach. Lippincott Williams & Wilcins, Philadelphia, pp 457–588
Varker KA, Martin EW, Klemanski D, Palmer B, Shah MH, Bloomston M (2007) Repeat transarterial chemoembolization (TACE) for progressive hepatic carcinoid metastases provides results similar to first TACE. J Gastrointest Surg 11:1680–1685
Venook AP (1999) Embolization and chemoembolization therapy for neuroendocrine tumours. Curr Opt Oncol 11:39–44
Vogl TJ, Naguib NNN, Zangos S, Eichler K, Hedayati A, Nour-Eldin N-E (2009a) Liver metastases of neuroendocrine carcinomas: interventional treatment via transarterial embolization, chemoembolization and thermal ablation. Eur J Radiol 72(3):517–528
Vogl TJ, Naguib NNN, Zangos S, Eichler K, Hedayati A, Nour-Eldin N-E (2009b) Liver metastases of neuroendocrine tumors: treatment with hepatic transarterial chemotherapy using two protocols. Am J Roentgenol 193:941–947
Williams ED, Sandler M (1963) The classification of carcinoid tumors. Lancet 1:238–239
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2014 Springer-Verlag Berlin Heidelberg
About this chapter
Cite this chapter
Petrovitch, A. et al. (2014). New Approaches: Combined Local and Multimodal Strategies in the Treatment of Complex Neuroendocrine Liver Metastases. In: Baum, R. (eds) Therapeutic Nuclear Medicine. Medical Radiology(). Springer, Berlin, Heidelberg. https://doi.org/10.1007/174_2012_783
Download citation
DOI: https://doi.org/10.1007/174_2012_783
Published:
Publisher Name: Springer, Berlin, Heidelberg
Print ISBN: 978-3-540-36718-5
Online ISBN: 978-3-540-36719-2
eBook Packages: MedicineMedicine (R0)