Elsevier

HPB

Volume 17, Issue 1, January 2015, Pages 29-37
HPB

Original Article
Role of hepatic intra-arterial therapies in metastatic neuroendocrine tumours (NET): guidelines from the NET-Liver-Metastases Consensus Conference

https://doi.org/10.1111/hpb.12326Get rights and content
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Abstract

Objectives

Liver metastasis from a neuroendocrine tumour (NET) represents a significant clinical entity. A multidisciplinary group of experts was convened to develop state-of-the-art recommendations for its management.

Methods

Peer-reviewed published reports on intra-arterial therapies for NET hepatic metastases were reviewed and the findings presented to a jury of peers. The therapies reviewed included transarterial embolization (TAE), transarterial chemoembolization (TACE) and radioembolization (RE). Two systems were used to evaluate the level of evidence in each publication: (i) the US National Cancer Institute (NCI) system, and (ii) the GRADE system.

Results

Eighteen publications were reviewed. These comprised 11 reports on TAE or TACE and seven on RE. Four questions posed to the panel were answered and recommendations offered.

Conclusions

Studies of moderate quality support the use of TAE, TACE and RE in hepatic metastases of NETs. The quality and strength of the reports available do not allow any modality to be determined as superior in terms of imaging response, symptomatic response or impact on survival. Radioembolization may have advantages over TAE and TACE because it causes fewer side-effects and requires fewer treatments. Based on current European Neuroendocrine Tumor Society (ENETS) Consensus Guidelines, RE can be substituted for TAE or TACE in patients with either liver-only disease or those with limited extrahepatic metastases.

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This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

Sources of funding: NIHR Biomedical Research Centre Oxford and the Oxford Cancer Imaging Centre.

This paper is based on the NET-Liver-Metastases Consensus Conference, 12–13 December 2012, London, endorsed by the European–African Hepato-Pancreato-Biliary Association (E-AHPBA), the European Neuroendocrine Tumor Society (ENETS), the Association of Upper Gastrointestinal Surgeons of Great Britain and Ireland (AUGIS), the European Society of Surgical Oncology (ESSO), the Great Britain and Ireland Hepato-Pancreato-Biliary Association (GBIHPBA), the International Hepato-Pancreato-Biliary Association (IHPBA) and the UK and Ireland Neuroendocrine Tumour Society (UKINETS).

Kennedy's institution received grant funding for clinical trial from Sirtex Medical. Bester received consultancy fees from Sirtex Medical. Salem, Parks, Ruszniewski and Sharma have no conflicts of interest.