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Sharma A, Muralitharan M, Ramage J, Clement D, Menon K, Srinivasan P, Elmasry M, Reed N, Seager M, Srirajaskanthan R. Current Management of Neuroendocrine Tumour Liver Metastases. Curr Oncol Rep 2024:10.1007/s11912-024-01559-w. [PMID: 38869667 DOI: 10.1007/s11912-024-01559-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2024] [Indexed: 06/14/2024]
Abstract
PURPOSE OF REVIEW This article aims to illustrate the current state of investigations and management of liver metastases in patients with Neuroendocrine Neoplasms. Neuroendocrine tumours (NETs) are rising in incidence globally and have become the second most prevalent gastrointestinal malignancy in UK and USA. Frequently, patients have metastatic disease at time of presentation. The liver is the most common site of metastases for gastro-enteropancreatic NETs. Characterisation of liver metastases with imaging is important to ensure disease is not under-staged. RECENT FINDINGS Magnetic resonance imaging and positron emission tomography are now becoming standard of care for imaging liver metastases. There is an increasing armamentarium of therapies available for management of NETs and loco-regional therapy for liver metastases. The data supporting surgical and loco-regional therapy is reviewed with focus on role of liver transplantation. It is important to use appropriate imaging and classification of NET liver metastases. It is key that decisions regarding approach to treatment is undertaken in a multidisciplinary team and that individualised approaches are considered for management of patients with metastatic NETs.
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Affiliation(s)
- Aditya Sharma
- Department of Gastroenterology, King's College Hospital, SE5 9RS, London, U.K
| | | | - John Ramage
- Neuroendocrine Tumour Unit, Institute of Liver Studies, King's College Hospital, SE5 9RS, London, U.K
| | - Dominique Clement
- Department of Gastroenterology, King's College Hospital, SE5 9RS, London, U.K
- Neuroendocrine Tumour Unit, Institute of Liver Studies, King's College Hospital, SE5 9RS, London, U.K
| | - Krishna Menon
- Institute of Liver Studies, King's College Hospital, SE5 9RS, London, U.K
| | - Parthi Srinivasan
- Institute of Liver Studies, King's College Hospital, SE5 9RS, London, U.K
| | - Mohamed Elmasry
- Institute of Liver Studies, King's College Hospital, SE5 9RS, London, U.K
| | - Nick Reed
- Department of Oncology, Beatson Centre, G12 0YN, Glasgow, U.K
| | - Matthew Seager
- Department of Radiology, King's College Hospital, SE5 9RS, London, U.K
| | - Rajaventhan Srirajaskanthan
- Department of Gastroenterology, King's College Hospital, SE5 9RS, London, U.K..
- Neuroendocrine Tumour Unit, Institute of Liver Studies, King's College Hospital, SE5 9RS, London, U.K..
- Neuroendocrine Tumour Unit Institute of liver studies, King's College Hospital, SE5 9RS, London, U.K..
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Nagesh VK, Aguilar IK, Elias D, Mansour C, Tran HHV, Bhuju R, Sethi T, Sanjeeva PRP, Rivas MG, Martinez E, Auda A, Ahmed N, Philip S, Weissman S, Sotiriadis J, Bangolo A. Factors Affecting Survival Outcomes in Neuroendocrine Tumor of the Appendix over the Past Two Decades. Diseases 2024; 12:96. [PMID: 38785751 PMCID: PMC11120129 DOI: 10.3390/diseases12050096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Revised: 05/01/2024] [Accepted: 05/06/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Appendiceal neuroendocrine tumors (NETs) rank as the third most frequent neoplasm affecting the appendix, originating from enterochromaffin cells. This study aims to evaluate the influence of various prognostic factors on the mortality rates of patients diagnosed with NETs of the appendix. METHODS Conducted retrospectively, the study involved 3346 patients, utilizing data sourced from the Surveillance, Epidemiology, and End Results (SEER) database. Our analysis centered on investigating demographic characteristics, clinical features, overall mortality (OM), and cancer-specific mortality (CSM) among the cohort. Variables showing a p-value < 0.1 in the univariate Cox regression were incorporated into the multivariate Cox regression analysis. A Hazard Ratio (HR) > 1 indicated an unfavorable prognosis. RESULTS In the multivariate analysis, higher OM and CSM were observed in males, older age groups, tumors with distant metastasis, poorly differentiated tumors, and those who underwent chemotherapy. Non-Hispanic Black individuals showed elevated mortality rates. CONCLUSION Delayed diagnosis may contribute to the increased mortality in this community. Improved access to healthcare and treatment is crucial for addressing these disparities. Larger prospective studies are needed to pinpoint the underlying causes of elevated mortality in non-Hispanic Black populations, and randomized controlled trials (RCTs) are warranted to evaluate therapies for advanced-stage appendix NETs.
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Affiliation(s)
- Vignesh Krishnan Nagesh
- Department of Internal Medicine, Hackensack Palisades Medical Center, North Bergen, NJ 07047, USA; (I.K.A.); (D.E.); (H.H.-V.T.); (E.M.); (S.W.)
| | - Izage Kianifar Aguilar
- Department of Internal Medicine, Hackensack Palisades Medical Center, North Bergen, NJ 07047, USA; (I.K.A.); (D.E.); (H.H.-V.T.); (E.M.); (S.W.)
| | - Daniel Elias
- Department of Internal Medicine, Hackensack Palisades Medical Center, North Bergen, NJ 07047, USA; (I.K.A.); (D.E.); (H.H.-V.T.); (E.M.); (S.W.)
| | - Charlene Mansour
- Department of Internal Medicine, Hackensack Palisades Medical Center, North Bergen, NJ 07047, USA; (I.K.A.); (D.E.); (H.H.-V.T.); (E.M.); (S.W.)
| | - Hadrian Hoang-Vu Tran
- Department of Internal Medicine, Hackensack Palisades Medical Center, North Bergen, NJ 07047, USA; (I.K.A.); (D.E.); (H.H.-V.T.); (E.M.); (S.W.)
| | - Ruchi Bhuju
- Department of Internal Medicine, Hackensack Palisades Medical Center, North Bergen, NJ 07047, USA; (I.K.A.); (D.E.); (H.H.-V.T.); (E.M.); (S.W.)
| | - Tanni Sethi
- Department of Internal Medicine, Hackensack Palisades Medical Center, North Bergen, NJ 07047, USA; (I.K.A.); (D.E.); (H.H.-V.T.); (E.M.); (S.W.)
| | - Paranjyothy Rao Pirangi Sanjeeva
- Department of Internal Medicine, Hackensack Palisades Medical Center, North Bergen, NJ 07047, USA; (I.K.A.); (D.E.); (H.H.-V.T.); (E.M.); (S.W.)
| | - Marco Gonzalez Rivas
- Department of Internal Medicine, Hackensack Palisades Medical Center, North Bergen, NJ 07047, USA; (I.K.A.); (D.E.); (H.H.-V.T.); (E.M.); (S.W.)
| | - Emelyn Martinez
- Department of Internal Medicine, Hackensack Palisades Medical Center, North Bergen, NJ 07047, USA; (I.K.A.); (D.E.); (H.H.-V.T.); (E.M.); (S.W.)
| | - Auda Auda
- Department of Internal Medicine, Hackensack Palisades Medical Center, North Bergen, NJ 07047, USA; (I.K.A.); (D.E.); (H.H.-V.T.); (E.M.); (S.W.)
| | - Nazir Ahmed
- Department of Gastroenterology, Hackensack Palisades Medical Center, North Bergen, NJ 07047, USA; (N.A.); (S.P.); (J.S.)
| | - Shawn Philip
- Department of Gastroenterology, Hackensack Palisades Medical Center, North Bergen, NJ 07047, USA; (N.A.); (S.P.); (J.S.)
| | - Simcha Weissman
- Department of Internal Medicine, Hackensack Palisades Medical Center, North Bergen, NJ 07047, USA; (I.K.A.); (D.E.); (H.H.-V.T.); (E.M.); (S.W.)
| | - John Sotiriadis
- Department of Gastroenterology, Hackensack Palisades Medical Center, North Bergen, NJ 07047, USA; (N.A.); (S.P.); (J.S.)
| | - Ayrton Bangolo
- Department of Internal Medicine, Hackensack Palisades Medical Center, North Bergen, NJ 07047, USA; (I.K.A.); (D.E.); (H.H.-V.T.); (E.M.); (S.W.)
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Marcus C, Muzahir S, Subramaniam RM. Quarter Century PET/Computed Tomography Transformation of Oncology: Neuroendocrine Tumors. PET Clin 2024; 19:187-196. [PMID: 38160070 DOI: 10.1016/j.cpet.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
Significant improvement in molecular imaging and theranostics in the management of neuroendocrine tumors (NETs) has been made in the last few decades. Somatostatin receptor-targeted PET imaging outperforms conventional, planar, and single-photon emission computed tomography imaging and is indicated in the evaluation of these patients when available, resulting in a significant impact on staging, treatment response assessment, and restaging of these patients. Radionuclide therapy can have an impact on patient outcome in metastatic disease when not many treatment options are available.
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Affiliation(s)
- Charles Marcus
- Division of Nuclear Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Road Northeast, E163, Atlanta, GA 30322, USA.
| | - Saima Muzahir
- Division of Nuclear Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Road Northeast, E163, Atlanta, GA 30322, USA
| | - Rathan M Subramaniam
- Faculty of Medicine, Nursing, Midwifery and Health Sciences, The University of Notre Dame Australia, 160 Oxford Street, Darlinghurst, New South Wales 2010, Australia; Department of Radiology, Duke University, Durham, NC, USA; Department of Medicine, Otago Medical School, The University of Otago, New Zealand
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DePietro DM, Li X, Shamimi-Noori SM. Chemoembolization Beyond Hepatocellular Carcinoma: What Tumors Can We Treat and When? Semin Intervent Radiol 2024; 41:27-47. [PMID: 38495263 PMCID: PMC10940046 DOI: 10.1055/s-0043-1777716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Liver metastases are the most common malignancy found in the liver and are 20 to 40 times more common than primary hepatic tumors, including hepatocellular carcinoma. Patients with liver metastases often present with advanced disease and are not eligible for curative-intent surgery or ablative techniques. The unique hepatic arterial blood supply of liver metastases allows interventional radiologists to target these tumors with transarterial therapies. Transarterial chemoembolization (TACE) has been studied in the treatment of liver metastases originating from a variety of primary malignancies and has demonstrated benefits in terms of hepatic progression-free survival, overall survival, and symptomatic relief, among other benefits. Depending on the primary tumor from which they originate, liver metastases may have different indications for TACE, may utilize different TACE regimens and techniques, and may result in different post-procedural outcomes. This review offers an overview of TACE techniques and specific considerations in the treatment of liver metastases, provides an in-depth review of TACE in the treatment of liver metastases originating from colorectal cancer, neuroendocrine tumor, and uveal melanoma, which represent some of the many tumors beyond hepatocellular carcinoma that can be treated by TACE, and summarizes data regarding when one should consider TACE in their treatment algorithms.
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Affiliation(s)
- Daniel M. DePietro
- Division of Interventional Radiology, Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Xin Li
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Susan M. Shamimi-Noori
- Division of Interventional Radiology, Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
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Rabei R, Fidelman N. Liver-Directed Therapy for Neuroendocrine Tumor Metastases in the Era of Peptide Receptor Radionuclide Therapy. Curr Treat Options Oncol 2023; 24:1994-2004. [PMID: 38100020 PMCID: PMC10781814 DOI: 10.1007/s11864-023-01152-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2023] [Indexed: 01/11/2024]
Abstract
OPINION STATEMENT The treatment of neuroendocrine neoplasm (NEN) liver metastases involves a multidisciplinary approach that includes liver-directed therapies (LDT) and systemic treatments, such as peptide receptor radionuclide therapy (PRRT). LDT has demonstrated efficacy in rapidly reducing tumor bulk, improving symptoms, and delaying disease progression. Interventional radiologists should be consulted prior to switching therapy for patients with progressive or symptomatic neuroendocrine tumor liver metastases. Long-term follow-up data on the safety of Yttrium-90 radioembolization before and after PRRT remain limited. Therefore, a more conservative approach may be to preferentially employ transarterial embolization (TAE) or transarterial chemoembolization (TACE) for patients' somatostatin receptor-avid disease who may be future candidates for PRRT. Notable exceptions where radioembolization may be a preferred treatment strategy may be patients with history of biliary tract instrumentation, asymmetric unilobar disease distribution, and rapidly progressive diffuse liver involvement. Selection of local treatment modality, sequencing, and combination of LDT with systemic therapy require further investigation.
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Affiliation(s)
- Rana Rabei
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Avenue, Room M-361, San Francisco, CA, 94143, USA
| | - Nicholas Fidelman
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Avenue, Room M-361, San Francisco, CA, 94143, USA.
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Harrelson A, Wang R, Stewart A, Ingram C, Gillis A, Rose JB, El-Rayes B, Azmi A, Chen H. Management of neuroendocrine tumor liver metastases. Am J Surg 2023; 226:623-630. [PMID: 37657968 DOI: 10.1016/j.amjsurg.2023.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 07/15/2023] [Accepted: 08/14/2023] [Indexed: 09/03/2023]
Abstract
BACKGROUND Neuroendocrine Tumors (NETs) are a group of tumors that arise from neuroendocrine cells, and are increasing in incidence worldwide. These tumors often metastasize to the liver, and management of these neuroendocrine tumor liver metastases (NELMs) requires a multi-disciplinary approach. We aim to provide a comprehensive update for treatment of NELMs. METHODS We completed a comprehensive systemic review of papers involving the diagnosis, treatment, and outcomes of NELMs. We identified 1612 records via Scopus database literature search. Two independent authors reviewed these records, with 318 meeting criteria for inclusion in the final systemic review. RESULTS Primary tumor resection with resection of liver metastases is the treatment of choice for patients with NELMs. Liver-directed therapies and liver transplantation can be considered for patients with unresectable liver metastases. Systemic medical therapy is used for managing tumor burden and symptoms caused by NELMs. CONCLUSIONS Advancement in liver-directed and targeted systemic therapies provide improved options for patients with unresectable tumors. Given the complexity of NELMs, management of NELMs necessitates multidisciplinary teams at comprehensive health centers.
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Affiliation(s)
- Alex Harrelson
- Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Rongzhi Wang
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Addison Stewart
- Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Clark Ingram
- Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Andrea Gillis
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - J Bart Rose
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Bassel El-Rayes
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Asfar Azmi
- Department of Oncology, Karmanos Cancer Institute, Detroit, MI, USA
| | - Herbert Chen
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.
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Sanli Y, Denizmen D, Subramaniam RM. Gastro-Enteric-Pancreatic Neuroendocrine Tumor Treatment: 177Lu-DOTATATE. PET Clin 2023; 18:201-214. [PMID: 36858745 DOI: 10.1016/j.cpet.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
177Lu-DOTA-TATE therapy is a highly effective therapy in metastatic, well-differentiated, somatostatin receptor-positive GEP-neuroendocrine tumors (NETs) with mostly tolerable adverse effects. Guidelines generally refer to peptide receptor radionuclide therapy as a second-line therapy after SSA in gastroenteric and second- or third-line therapy in pancreatic NETs to improve survival rates and quality of life. Although we do not have sufficient data, 177Lu-DOTA-TATE therapy may also have a role in high-grade NET therapy, mostly in combination with other treatments such as chemotherapy.
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Affiliation(s)
- Yasemin Sanli
- Department of Nuclear Medicine, Istanbul Faculty of Medicine, Istanbul University, Millet Caddesi, Istanbul 34390, Turkey.
| | - Dilara Denizmen
- Department of Nuclear Medicine, Istanbul Faculty of Medicine, Istanbul University, Millet Caddesi, Istanbul 34390, Turkey
| | - Rathan M Subramaniam
- Dean's Office, Otago Medical School, University of Otago, Dunedin 9016, New Zealand; Department of Radiology, Duke University, Durham, NC, USA
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Management of Appendix Neuroendocrine Neoplasms: Insights on the Current Guidelines. Cancers (Basel) 2022; 15:cancers15010295. [PMID: 36612291 PMCID: PMC9818268 DOI: 10.3390/cancers15010295] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 12/19/2022] [Accepted: 12/26/2022] [Indexed: 01/03/2023] Open
Abstract
Appendiceal neuroendocrine neoplasms (ANENs) usually present as incidental findings at the time of appendectomy for acute appendicitis. They are rare, accounting for only 0.5-1% of intestinal neoplasms; they are found in 0.3-0.9% of all appendectomy specimens. They are usually sporadic tumors. There are several histological types including well-differentiated neuroendocrine tumors (NETs), poorly differentiated neuroendocrine carcinomas (NECs), and mixed neuroendocrine-non-neuroendocrine neoplasms (MiNENs). Histologic differentiation and the grade of well-differentiated NETs correlate with clinical behavior and prognosis. Management varies based on differentiation, aggressiveness, and metastatic potential. There is debate about the optimal surgical management for localized appendiceal NETs that are impacted by many factors including the tumor size, the extent of mesoappendiceal spread, lymphovascular invasion and perineural involvement. In addition, the data to guide therapy in metastatic disease are limited due to the paucity of these tumors. Here, we review the current advances in the management of ANENs within the context of a multidisciplinary approach to these tumors.
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