Editorial
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 21, 2017; 23(15): 2640-2650
Published online Apr 21, 2017. doi: 10.3748/wjg.v23.i15.2640
Is there still a role for the hepatic locoregional treatment of metastatic neuroendocrine tumors in the era of systemic targeted therapies?
Federica Cavalcoli, Emanuele Rausa, Dario Conte, Antonio Federico Nicolini, Sara Massironi
Federica Cavalcoli, Dario Conte, Sara Massironi, Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
Federica Cavalcoli, Dario Conte, Postgraduate School of Gastroenterology, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, 20122 Milan, Italy
Emanuele Rausa, Department of Colorectal Diseases, St. Vincent’s University Hospital, Elm Park, Dublin 8, Dublin, Ireland
Antonio Federico Nicolini, Department of Interventional Radiology, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
Author contributions: Cavalcoli F and Massironi S planned the work; Rausa E performed the literature search; Rausa E and Cavalcoli F wrote the first draft of the manuscript; Cavalcoli F and Rausa E edited the subsequent versions of the manuscript; Conte D, Nicolini AF and Massironi S critically revised the manuscript for relevant intellectual content; Finally, all the authors read and approved the final manuscript.
Conflict-of-interest statement: The authors declare no conflict of interest related to this publication.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Federica Cavalcoli, MD, Gastroenterology and Endoscopic Unit, Fondazione IRCCS Ca’ Granda - Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milano, Italy. cavalcoli.federica@gmail.com
Telephone: +39-2-55033444 Fax: +39-2-55033644
Received: February 7, 2017
Peer-review started: February 10, 2017
First decision: February 23, 2017
Revised: March 11, 2017
Accepted: March 20, 2017
Article in press: March 20, 2017
Published online: April 21, 2017
Processing time: 81 Days and 15.1 Hours
Abstract

Gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs) frequently present with distant metastases at the time of diagnosis and the liver is the most frequent site of spreading. The early identification of metastatic disease represents a major prognostic factor for GEP-NENs patients. Radical surgical resection, which is feasible for a minority of patients, is considered the only curative option, while the best management for patients with unresectable liver metastases is still being debated. In the last few years, a number of locoregional and systemic treatments has become available for GEP-NEN patients metastatic to the liver. However, to date only a few prospective studies have compared those therapies and the optimal management option is based on clinical judgement. Additionally, locoregional treatments appear feasible and safe for disease control for patients with limited liver involvement and effective in symptoms control for patients with diffuse liver metastases. Considering the lack of randomized controlled trials comparing the locoregional treatments of liver metastatic NEN patients, clinical judgment remains key to set the most appropriate therapeutic pathway. Prospective data may ultimately lead to more personalized and optimized treatments. The present review analyzes all the locoregional therapy modalities (i.e., surgery, ablative treatments and transarterial approach) and aims to provide clinicians with a useful algorithm to best treat GEP-NEN patients metastatic to the liver.

Keywords: Gastroenteropancreatic neuroendocrine neoplasms; Liver metastases; Locoregional therapies; Systemic therapies; Ablation; Chemoembolization

Core tip: Gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs) frequently present with distant metastases. In the last years, a number of treatment has become available for advanced GEP-NENs and the optimal management for these patients remains to be established. While systemic medical therapies and peptide receptor radionuclide therapy represent effective options, they are usually palliative whereas liver-directed treatments often represent the only possibly curative therapy, even if not supported by prospective trials. Considering the lack of randomized trials comparing locoregional treatments in advanced GEP-NEN, clinical judgment remains key to set the most appropriate therapeutic pathway. Prospective data may lead to more personalized and optimized treatments.