The Landmark Series: Neuroendocrine Tumor Liver Metastases

INTRODUCTION: Neuroendocrine tumors are becoming increasingly prevalent with many patients presenting with or developing metastatic disease to the liver. METHODS: In this landmark series paper, we highlight the critical studies that have defined the surgical management of neuroendocrine tumor liver metastases, as well as several randomized control trials which have investigated strategies for systemic control of metastatic disease. RESULTS: Liver-directed surgical approaches and locally ablative procedures are recommended for patients with limited, resectable and in some cases, nonresectable tumor burden. Angiographic liver-directed techniques, such as transarterial embolization, chemoembolization, and radioembolization, offer another approach for management in patients with liver-predominant disease. Peptide receptor radionuclide therapy is a promising therapy for patients with hepatic and/or extrahepatic metastases. Various systemic medical therapies are also available as adjunct or definitive therapy for patients with metastatic disease. CONCLUSION: This article will review the current data regarding management of neuroendocrine liver metastases and highlight areas for future study.