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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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