Table 1. Transarterial Embolization Versus Chemoembolization for Neuroendocrine Tumor Liver Metastases

Table 2. Drug-Eluting Beads Transarterial Chemoembolization

Table 3. Radioembolization

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Sward C, Johanson V, Nieveen van Dijkum E, et al. Prolonged survival after hepatic artery embolization in patients with midgut carcinoid. Br J Surg 2009;96:517–521.
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Author(s)

Natalie B. Jones, MD

Department of Surgery, The Ohio State University, Columbus, Ohio

Disclosures

Disclosure: Natalie B. Jones, MD, has disclosed no relevant financial relationships.

Manisha H. Shah, MD

Department of Hematology/Oncology, The Ohio State University, Columbus, Ohio

Disclosures

Disclosure: Manisha H. Shah, MD, has disclosed no relevant financial relationships.

Mark Bloomston, MD

Department of Surgery, The Ohio State University, Columbus, Ohio

Disclosures

Disclosure: Mark Bloomston, MD, has disclosed no relevant financial relationships.

Editor

Kerrin M. Green, MA

Assistant Managing Editor, Journal of the National Comprehensive Cancer Network

Disclosures

Disclosure: Kerrin M. Green, MA, has disclosed no relevant financial relationships.

CME Author

Charles P. Vega, MD, FAAFP

Health Sciences Clinical Professor; Residency Director, Department of Family Medicine, University of California, Irvine

Disclosures

Disclosure: Charles P. Vega, MD, FAAFP, has disclosed no relevant financial relationships.

CME Reviewer

Nafeez Zawahir, MD

CME Clinical Director, Medscape, LLC

Disclosures

Disclosure: Nafeez Zawahir, MD, has disclosed no relevant financial relationships.

CME

Liver-Directed Therapies in Patients With Advanced Neuroendocrine Tumors

Authors: Natalie B. Jones, MD; Manisha H. Shah, MD; Mark Bloomston, MD
CME Released: 6/4/2012
THIS ACTIVITY HAS EXPIRED FOR CREDIT
Valid for credit through: 6/4/2013, 11:59 PM EST

Start Activity

Target Audience and Goal Statement

This activity is intended for primary care physicians, oncologists, gastroenterologists, surgeons, and other physicians who care for patients with NETs.

The goal of this activity is to evaluate treatment strategies for liver metastases of NETs.

Upon completion of this activity, participants will be able to:

Distinguish the most important prognostic factor for survival in cases of NETs
Analyze surgical options for the treatment of liver metastases associated with NETs
Assess the use of embolization of liver metastases associated with NETs
Evaluate other treatment modalities of liver metastases associated with NETs

Disclosures

Author(s)

Natalie B. Jones, MD

Department of Surgery, The Ohio State University, Columbus, Ohio

Disclosures

Disclosure: Natalie B. Jones, MD, has disclosed no relevant financial relationships.

Manisha H. Shah, MD

Department of Hematology/Oncology, The Ohio State University, Columbus, Ohio

Disclosures

Disclosure: Manisha H. Shah, MD, has disclosed no relevant financial relationships.

Mark Bloomston, MD

Department of Surgery, The Ohio State University, Columbus, Ohio

Disclosures

Disclosure: Mark Bloomston, MD, has disclosed no relevant financial relationships.

Editor

Kerrin M. Green, MA

Assistant Managing Editor, Journal of the National Comprehensive Cancer Network

Disclosures

Disclosure: Kerrin M. Green, MA, has disclosed no relevant financial relationships.

CME Author

Charles P. Vega, MD, FAAFP

Health Sciences Clinical Professor; Residency Director, Department of Family Medicine, University of California, Irvine

Disclosures

Disclosure: Charles P. Vega, MD, FAAFP, has disclosed no relevant financial relationships.

CME Reviewer

Nafeez Zawahir, MD

CME Clinical Director, Medscape, LLC

Disclosures

Disclosure: Nafeez Zawahir, MD, has disclosed no relevant financial relationships.

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From JNCCN - Journal of the National Comprehensive Cancer Network

CME

Liver-Directed Therapies in Patients With Advanced Neuroendocrine Tumors

Authors: Natalie B. Jones, MD; Manisha H. Shah, MD; Mark Bloomston, MDFaculty and Disclosures

THIS ACTIVITY HAS EXPIRED FOR CREDIT

CME Released: 6/4/2012

Valid for credit through: 6/4/2013, 11:59 PM EST

processing....

Abstract and Introduction

Abstract

Neuroendocrine tumors (NETs) are increasing in incidence. Incidental NETs that may have little clinical significance, such as gastric and rectal primaries, are often identified because of increased screening efforts and advanced imaging modalities. Although NETs are biologically indolent cancers, many patients present with incurable metastatic disease to the liver at initial diagnosis. Some literature suggests a delay averaging almost 5 years in making the correct diagnosis based on clinical symptoms. Although surgical resection offers the only potentially curative therapy, liver-directed therapies, such as embolization and ablation, offer effective alternatives to control symptoms and potentially impact overall survival. This article reviews the latest liver-directed approaches to the management of advanced NETs. (JNCCN 2012;10:765–774)

Introduction

Neuroendocrine tumors (NETs) are rare, with a rising incidence over the past few decades of 5 to 7 cases per 100,000.^[1,2] Gastroenteropancreatic NETs have the second highest prevalence of all gastrointestinal cancers. Not surprisingly, the liver is the most common site of metastases, in addition to regional lymph nodes. As many as 75% of small bowel NETs and 30% to 85% of pancreatic NETs present either synchronous or metachronous with liver metastases.^[1,3] In addition, 5% to 10% of patients with NETs present with liver metastases as their initial presentation, with primaries of unknown origin. It has been shown that hepatic metastases are the most important prognostic indicator of survival in patients with NETs regardless of the primary site.^[4] Historically, 5-year survival rates for untreated neuroendocrine liver metastases range from 13% to 54% compared with 75% to 99% in patients without liver metastases.^[5,6] Progression of liver metastases associated with bony metastases can often be seen in NETs and is an indicator of aggressive disease. Therefore, distinction is often made between treatment modalities based on aggressiveness of tumor and extent of extrahepatic metastasis. The presence of liver metastases and their patterns of distribution are prognostic indicators.^[7,8]

Currently, consensus is lacking regarding how NET liver metastases should be managed, specifically regarding the goals of therapy (curative vs. palliative), indication for initiation of treatment (tumor burden, symptoms), and optimal means to achieve these objectives (systemic therapy, surgery, percutaneous interventions).^[9] This article focuses on liver-directed therapies for metastatic NETs, specifically the role of cytoreductive hepatectomy, liver transplantation, and percutaneous interventions (e.g., ablation, chemoembolization, radioembolization). Given the propensity for poorly differentiated tumors to be treated with systemic therapy, this discussion is limited to the management of low-grade (i.e., well-differentiated and moderately differentiated) tumors.

Page 1 of 7

Surgical Resection

CME Information

Abstract and Introduction
Surgical Resection
Liver Transplantation
Transcatheter Arterial Embolization and Chemoembolization
Radioembolization
Thermal Ablation
Conclusions

References

References

Disclaimer

The material presented here does not necessarily reflect the views of Medscape, LLC, or companies that support educational programming on medscape.org. These materials may discuss therapeutic products that have not been approved by the US Food and Drug Administration and off-label uses of approved products. A qualified healthcare professional should be consulted before using any therapeutic product discussed. Readers should verify all information and data before treating patients or employing any therapies described in this educational activity.

Published by Harborside Press

Table 1. Transarterial Embolization Versus Chemoembolization for Neuroendocrine Tumor Liver Metastases

Table 2. Drug-Eluting Beads Transarterial Chemoembolization

Table 3. Radioembolization

References

Faculty and Disclosures

Author(s)

Natalie B. Jones, MD

Manisha H. Shah, MD

Mark Bloomston, MD

Editor

Kerrin M. Green, MA

CME Author

Charles P. Vega, MD, FAAFP

CME Reviewer

Nafeez Zawahir, MD

CME

Liver-Directed Therapies in Patients With Advanced Neuroendocrine Tumors

Target Audience and Goal Statement

Disclosures

Author(s)

Natalie B. Jones, MD

Manisha H. Shah, MD

Mark Bloomston, MD

Editor

Kerrin M. Green, MA

CME Author

Charles P. Vega, MD, FAAFP

CME Reviewer

Nafeez Zawahir, MD

Accreditation Statements

For Physicians

Instructions for Participation and Credit

Liver-Directed Therapies in Patients With Advanced Neuroendocrine Tumors

Abstract and Introduction

Abstract

Introduction

Table of Contents