Metastatic neuroendocrine tumors of the gastrointestinal tract and pancreas: A surgeon's plea to centering attention on the liver

Xavier M. Keutgen, Erik Schadde, Rodney Pommier, Thorvardur R. Halfdanarson, James R. Howe, Electron Kebebew

    Research output: Contribution to journalArticle

    1 Citation (Scopus)

    Abstract

    Over 50% of patients with gastroenteropancreatic neuroendocrine tumors (GEP-NETs) have stage IV disease at presentation and the most likely organ to be affected by metastases is the liver. Hepatic involvement and hepatic tumor burden is a key prognostic factor affecting survival of these patients and 80% eventually die of liver failure due to tumor dissemination within the liver. This commentary explores the efficacy and limitations of systemic treatments in patients with GEP-NETs and liver metastases. Landmark randomized trials using systemic therapies including sandostatin (PROMID), lanreotide (CLARINET), everolimus (RADIANT 3 and 4), sunitinib and Peptide Receptor Radionuclide Therapy (NETTER-1) have not shown efficacy in reducing liver tumor burden in patients with stage IV GEP-NETs with liver metastases as outlined in this review. Although often overlooked, surgical debulking has been associated with a significant survival advantage in large retrospective studies and in our opinion should remain an important therapeutic option for patients with stage IV GEP-NETs and liver metastases.

    Original languageEnglish (US)
    JournalSeminars in Oncology
    DOIs
    StateAccepted/In press - Jan 1 2018

    Fingerprint

    Neuroendocrine Tumors
    Gastrointestinal Tract
    Pancreas
    Liver
    Neoplasm Metastasis
    Tumor Burden
    Octreotide
    Peptide Receptors
    Survival
    Surgeons
    Liver Failure
    Therapeutics
    Radioisotopes
    Retrospective Studies
    Gastro-enteropancreatic neuroendocrine tumor

    Keywords

    • Liver metastases
    • Liver resection
    • Neuroendocrine tumor
    • Systemic therapy

    ASJC Scopus subject areas

    • Hematology
    • Oncology

    Cite this

    Metastatic neuroendocrine tumors of the gastrointestinal tract and pancreas : A surgeon's plea to centering attention on the liver. / Keutgen, Xavier M.; Schadde, Erik; Pommier, Rodney; Halfdanarson, Thorvardur R.; Howe, James R.; Kebebew, Electron.

    In: Seminars in Oncology, 01.01.2018.

    Research output: Contribution to journalArticle

    Keutgen, Xavier M. ; Schadde, Erik ; Pommier, Rodney ; Halfdanarson, Thorvardur R. ; Howe, James R. ; Kebebew, Electron. / Metastatic neuroendocrine tumors of the gastrointestinal tract and pancreas : A surgeon's plea to centering attention on the liver. In: Seminars in Oncology. 2018.
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