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arterial therapies (embolization/chemoembolization), may   2012;6:357-69.
            be useful in reducing tumor burden only in selected cases.   7.   Frilling A, Li J, Malamutmann E, Schmid KW, Bockisch A, Broelsch
            Application of the concept of tumor response as defined by   CE. Treatment of liver metastases from neuroendocrine tumours in
            RECIST or WHO criteria in patients with metastatic NETs   8.   relation to the extent of hepatic disease. Br J Surg 2009;96:175-84.
                                                                  Frilling A, Modlin IM, Kidd M, Russell C, Breitenstein S, Salem
            is worthy of mention. Often it is difficult to select the target   R, Kwekkeboom D, Lau  WY, Klersy C,  Vilgrain  V, Davidson
            lesions to be monitored over time. Furthermore, necrosis   B, Siegler M, Caplin M, Solcia E, Schilsky R;  Working Group
            or hemorrhage within other clinical occurrences may be   on Neuroendocrine  Liver Metastases. Recommendations  for
            misinterpreted as a stable disease instead of a response.  management  of patients  with neuroendocrine  liver  metastases.
                                                                  Lancet Oncol 2014;15:e8-21.
            In conclusion, while  surgical  management  of resectable   9.   García-Carbonero R, Capdevila J, Crespo- Herrero G, Díaz-Pérez
                                                                  JA, Martínez Del Prado MP, Alonso Orduña V, Sevilla-García I,
            LM from NETs is a standardized procedure, there is no   Villabona-Artero  C, Beguiristain-Gómez  A, Llanos-Muñoz  M,
            consensus on the best therapeutic  strategy for all other   Marazuela M, Alvarez-Escola C, Castellano D, Vilar E, Jiménez-
            patients.  For  example,  it  is  a  matter  of  debate  whether   Fonseca  P,  Teulé  A,  Sastre-Valera  J,  Benavent-Viñuelas  M,
            incomplete surgical resection of bulky but asymptomatic   Monleon A, Salazar R. Incidence, patterns of care and prognostic
            metastasis from NETs is preferable to systemic biotherapy.   factors for outcome of gastroenteropancreatic  neuroendocrine
            Extremely  promising recent  data  have been reported  in   tumors (GEP-NETs): results from the National Cancer Registry of
                                                                  Spain (RGETNE). Ann Oncol 2010;21:1794-803.
            the Radiant  4 trial, suggesting that novel therapies  (in   10.  Ekeblad S, Skogseid B, Dunder K, Oberg K, Eriksson B. Prognostic
            particular  the mTOR inhibitor  everolimus)  will play an   factors and survival in  324 patients with pancreatic endocrine
            increasingly important role in the management of advanced   tumortreated at a single institution. Clin Cancer Res 2008;14:7798-803.
            LM irrespective of the extent of liver metastasis.  11.  Bettini R, Boninsegna L, Mantovani W, Capelli P, Bassi C, Pederzoli
                                                                  P,  Delle  Fave  GF,  Panzuto  F,  Scarpa  A,  Falconi  M.  Prognostic
            Large prospective studies are needed to evaluate  the   factors at diagnosis and value of WHO classification in a mono-
            optimal  management  of hepatic  metastases  from NETs,   institutional  series of 180 non-functioning pancreatic  endocrine
            defining common guidelines and allowing the choice of   tumours. Ann Oncol 2008;19:903-8.
            the best treatment strategy for each individual patient.  12.  Khasraw M, Gill A, Harrington T, Pavlakis N, Modlin I. Management
                                                                  of advanced neuroendocrine tumors with hepatic metastasis. J Clin
                                                                  Gastroenterol 2009;43:838-47.
            Financial support and sponsorship                 13.  Mayo SC, de Jong MC, Pulitano C, Clary BM, Reddy SK, Gamblin
            Nil.                                                  TC,  Celinksi  SA, Kooby DA, Staley  CA, Stokes  JB, Chu  CK,
                                                                  Ferrero  A,  Schulick  RD,  Choti  MA,Mentha  G,  Strub  J,  Bauer
            Conflicts of interest                                 TW, Adams RB, Aldrighetti L, Capussotti L, Pawlik TM. Surgical
            There are no conflicts of interest.                   management  of  hepatic  neuroendocrine  tumor  metastasis:  results
                                                                  from an international multi-institutional analysis. Ann Surg Oncol
                                                                  2010;17:3129-36.
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