Subscribe to RSS
DOI: 10.1055/a-1830-8442
Differenzierte Therapiestrategie bei Lebermetastasen gastro-entero-pankreatischer Neuroendokriner Neoplasien
Differentiated Strategies for the Therapy of Liver Metastases in Gastro-entero-pancreatic Neuroendocrine NeoplasiaZusammenfassung
Neuroendokrine Neoplasien (NEN) bilden eine heterogene Gruppe maligner Tumoren, die überwiegend dem gastro-entero-pankreatischen System (GEP) zuzuordnen sind. Hierbei sind Dünndarm und Pankreas die häufigsten Organe für Primärtumoren, die Leber stellt den dominanten Metastasierungsort dar. Da viele Patient*innen lange asymptomatisch bleiben, führen oftmals zufällig diagnostizierte Lebermetastasen oder ein Ileus zur Diagnose. Die einzige kurative Therapieoption stellt die komplette Entfernung von Primarius und Metastasen dar. Besonders im Falle der metastasierten Erkrankung sollten die vorhandenen Therapieoptionen immer im interdisziplinären Tumorboard mit Spezialisten*innen aus Gastroenterologie, (Leber-)Chirurgie, Radiologie, Nuklearmedizin, Radiotherapie, Pathologie und Endokrinologie evaluiert werden. Durch die Kombination der verschiedenen Therapieverfahren kann auch für Patient*innen mit fortgeschrittener Erkrankung eine jahrelange Prognose bei guter Lebensqualität erreicht werden. Wichtig für die Therapieentscheidung sind neben patientenindividuellen Faktoren der Differenzierungsgrad des Tumors, dessen hormonelle Sekretion, das Metastasierungsmuster und der Erkrankungsverlauf. Die Behandlung von Lebermetastasen umfasst neben den unterschiedlichen chirurgischen Strategien die lokal-ablativen radiologischen und nuklearmedizinischen Verfahren, die als Ergänzung zu den systemischen Therapien zur Verfügung stehen.
Abstract
Neuroendocrine neoplasias comprise a heterogenous group of malignant tumours, mostly arising from the gastro-entero-pancreatic system (GEP). Most of these tumours develop from the small intestine and pancreas and the liver is the predominant site for distant metastases. Patients may be asymptomatic for a long time and liver metastases are frequently diagnosed by chance or during operations for bowel obstruction, for example, during emergency surgery. The only curative therapy consists in complete removal of primary and metastases. In case of metastatic disease, various treatment modalities need to be discussed in interdisciplinary tumour boards comprised of specialists from gastroenterology, (liver-)surgery, radiology, nuclear medicine, radiotherapy, pathology and endocrinology. By combining different therapies, even patients with progressive disease may reach long-term overall survival with good quality of life. The most important factors for decisions on therapy are individual factors like tumour grading, hormonal functionality, type of metastases and evolution of the disease. Adequate treatment of liver metastases comprises various surgical strategies as well as locally ablative radiological interventions and nuclear medical therapies, in complement to systemic treatments.
Schlüsselwörter
neuroendokrine Neoplasie - neuroendokriner Tumor - lokalablative Therapie - Nuklearmedizin - LebermetastaseKeywords
liver metastasis - neuroendocrine neoplasia - neuroendocrine tumor - locally ablative therapy - Nuclear medicinePublication History
Received: 11 February 2022
Accepted after revision: 14 April 2022
Article published online:
15 June 2022
© 2022. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
-
Literatur
- 1 Dasari A, Shen C, Halperin D. et al. Trends in the Incidence, Prevalence, and Survival Outcomes in Patients With Neuroendocrine Tumors in the United States. JAMA Oncol 2017; 3: 1335-1342 DOI: 10.1001/jamaoncol.2017.0589. (PMID: 28448665)
- 2 Scherübl H, Streller B, Stabenow R. et al. Clinically detected gastroenteropancreatic neuroendocrine tumors are on the rise: epidemiological changes in Germany. World J Gastroenterol 2013; 19: 9012-9019 DOI: 10.3748/wjg.v19.i47.9012. (PMID: 24379626)
- 3 Pavel M, O’Toole D, Costa F. Vienna Consensus Conference participants. et al. ENETS Consensus Guidelines Update for the Management of Distant Metastatic Disease of Intestinal, Pancreatic, Bronchial Neuroendocrine Neoplasms (NEN) and NEN of Unknown Primary Site. Neuroendocrinology 2016; 103: 172-185 DOI: 10.1159/000443167. (PMID: 30153686)
- 4 Frilling A, Clift AK. Therapeutic strategies for neuroendocrine liver metastases. Cancer 2015; 121: 1172-1186 DOI: 10.1002/cncr.28760. (PMID: 25274401)
- 5 Norlén O, Stålberg P, Öberg K. et al. Long-term results of surgery for small intestinal neuroendocrine tumors at a tertiary referral center. World J Surg 2012; 36: 1419-1431 DOI: 10.1007/s00268-011-1296-z. (PMID: 21984144)
- 6 Frilling A, Modlin IM, Kidd M. Working Group on Neuroendocrine Liver Metastases. et al. Recommendations for management of patients with neuroendocrine liver metastases. Lancet Oncol 2014; 15: e8-e21 DOI: 10.1016/S1470-2045(13)70362-0. (PMID: 24384494)
- 7 Frilling A, Li J, Malamutmann E. et al. Treatment of liver metastases from neuroendocrine tumours in relation to the extent of hepatic disease. Br J Surg 2009; 96: 175-184 DOI: 10.1002/bjs.6468.
- 8 Pavel M, Öberg K, Falconi M. ESMO Guidelines Committee. et al. Gastroenteropancreatic neuroendocrine neoplasms: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2020; 31: 844-860 DOI: 10.1016/j.annonc.2020.03.304. (PMID: 32272208)
- 9 Norlén O, Stålberg P, Zedenius J. et al. Outcome after resection and radiofrequency ablation of liver metastases from small intestinal neuroendocrine tumours. Br J Surg 2013; 100: 1505-1514 DOI: 10.1002/bjs.9262. (PMID: 24037573)
- 10 Selberherr A, Freermann S, Koperek O. et al. Neuroendocrine liver metastasis from the small intestine: Is surgery beneficial for survival?. Orphanet J Rare Dis 2021; 16: 30 DOI: 10.1186/s13023-021-01677-9. (PMID: 33446229)
- 11 Sham JG, Ejaz A, Gage MM. et al. The Impact of Extent of Liver Resection Among Patients with Neuroendocrine Liver Metastasis: an International Multi-institutional Study. J Gastrointest Surg 2019; 23: 484-491 DOI: 10.1007/s11605-018-3862-2. (PMID: 29980977)
- 12 Bacchetti S, Pasqual EM, Bertozzi S. et al. Curative versus palliative surgical resection of liver metastases in patients with neuroendocrine tumors: a meta-analysis of observational studies. Gland Surg 2014; 3: 243-251 DOI: 10.3978/j.issn.2227-684X.2014.02.05. (PMID: 25493256)
- 13 Saxena A, Chua TC, Sarkar A. et al. Progression and survival results after radical hepatic metastasectomy of indolent advanced neuroendocrine neoplasms (NENs) supports an aggressive surgical approach. Surgery 2011; 149: 209-220 DOI: 10.1016/j.surg.2010.06.008. (PMID: 20674950)
- 14 Sarmiento JM, Heywood G, Rubin J. et al. Surgical treatment of neuroendocrine metastases to the liver: a plea for resection to increase survival. J Am Coll Surg 2003; 197: 29-37 DOI: 10.1016/S1072-7515(03)00230-8. (PMID: 12831921)
- 15 Feldbrügge L, Wabitsch S, Benzing C. et al. Safety and feasibility of laparoscopic liver resection in patients with a history of abdominal surgeries. HPB (Oxford) 2020; 22: 1191-1196 DOI: 10.1016/j.hpb.2019.11.006. (PMID: 31831317)
- 16 Schoening WN, Denecke T, Neumann UP. Präoperative Bildgebung/Operationsplanung für die Leberchirurgie. Chirurg 2015; 86: 1167-1179 DOI: 10.1007/s00104-015-0107-8.
- 17 AWMF. Leitlinien-Detailansicht Neuroendokrine Tumore. Registernummer 021–026. https://www.awmf.org/leitlinien/detail/ll/021–026.html
- 18 Pu N, Habib JR, Bejjani M. et al. The effect of primary site, functional status and treatment modality on survival in gastroenteropancreatic neuroendocrine neoplasms with synchronous liver metastasis: a US population-based study. Ann Transl Med 2021; 9: 329 DOI: 10.21037/atm-20-5348. (PMID: 33708956)
- 19 Maxwell JE, Sherman SK, O’Dorisio TM. et al. Liver-directed surgery of neuroendocrine metastases: What is the optimal strategy?. Surgery 2016; 159: 320-333 DOI: 10.1016/j.surg.2015.05.040. (PMID: 26454679)
- 20 Sham JG, Ejaz A, Gage MM. et al. The Impact of Extent of Liver Resection Among Patients with Neuroendocrine Liver Metastasis: an International Multi-institutional Study. J Gastrointest Surg 2019; 23: 484-491 DOI: 10.1007/s11605-018-3862-2. (PMID: 29980977)
- 21 Makuuchi M, Thai BL, Takayasu K. et al. Preoperative portal embolization to increase safety of major hepatectomy for hilar bile duct carcinoma: a preliminary report. Surgery 1990; 107: 521-527 (PMID: 2333592)
- 22 Adam R, Laurent A, Azoulay D. et al. Two-stage hepatectomy: A planned strategy to treat irresectable liver tumors. Ann Surg 2000; 232: 777-785 DOI: 10.1097/00000658-200012000-00006. (PMID: 11088072)
- 23 Kianmanesh R, Farges O, Abdalla EK. et al. Right portal vein ligation: a new planned two-step all-surgical approach for complete resection of primary gastrointestinal tumors with multiple bilateral liver metastases. J Am Coll Surg 2003; 197: 164-170 DOI: 10.1016/S1072-7515(03)00334-X. (PMID: 12831938)
- 24 Schnitzbauer AA, Lang SA, Goessmann H. et al. Right portal vein ligation combined with in situ splitting induces rapid left lateral liver lobe hypertrophy enabling 2-staged extended right hepatic resection in small-for-size settings. Ann Surg 2012; 255: 405-414 DOI: 10.1097/SLA.0b013e31824856f5. (PMID: 22330038)
- 25 Kianmanesh R, Sauvanet A, Hentic O. et al. Two-step surgery for synchronous bilobar liver metastases from digestive endocrine tumors: a safe approach for radical resection. Ann Surg 2008; 247: 659-665 DOI: 10.1097/SLA.0b013e31816a7061. (PMID: 18362629)
- 26 Linecker M, Kambakamba P, Raptis DA. et al. ALPPS in neuroendocrine liver metastases not amenable for conventional resection – lessons learned from an interim analysis of the International ALPPS Registry. HPB (Oxford) 2020; 22: 537-544 DOI: 10.1016/j.hpb.2019.08.011. (PMID: 31540885)
- 27 Elf AK, Andersson M, Henrikson O. et al. Radioembolization Versus Bland Embolization for Hepatic Metastases from Small Intestinal Neuroendocrine Tumors: Short-Term Results of a Randomized Clinical Trial. World J Surg 2018; 42: 506-513 DOI: 10.1007/s00268-017-4324-9. (PMID: 29167951)
- 28 Kennedy A, Bester L, Salem R. NET-Liver-Metastases Consensus Conference. et al. Role of hepatic intra-arterial therapies in metastatic neuroendocrine tumours (NET): guidelines from the NET-Liver-Metastases Consensus Conference. HPB (Oxford) 2015; 17: 29-37 DOI: 10.1111/hpb.12326. (PMID: 25186181)
- 29 Scott AT, Breheny PJ, Keck KJ. et al. Effective cytoreduction can be achieved in patients with numerous neuroendocrine tumor liver metastases (NETLMs). Surgery 2019; 165: 166-175 DOI: 10.1016/j.surg.2018.04.070. (PMID: 30343949)
- 30 Chan DL, Dixon M, Law CHL. et al. Outcomes of Cytoreductive Surgery for Metastatic Low-Grade Neuroendocrine Tumors in the Setting of Extrahepatic Metastases. Ann Surg Oncol 2018; 25: 1768-1774 DOI: 10.1245/s10434-018-6433-6. (PMID: 29560571)
- 31 Wonn SM, Limbach KE, Pommier SJ. et al. Outcomes of cytoreductive operations for peritoneal carcinomatosis with or without liver cytoreduction in patients with small bowel neuroendocrine tumors. Surgery 2021; 169: 168-174 DOI: 10.1016/j.surg.2020.03.030. (PMID: 32473829)
- 32 Ejaz A, Reames BN, Maithel S. et al. Cytoreductive debulking surgery among patients with neuroendocrine liver metastasis: a multi-institutional analysis. HPB (Oxford) 2018; 20: 277-284 DOI: 10.1016/j.hpb.2017.08.039. (PMID: 28964630)
- 33 Le Treut YP, Grégoire E, Klempnauer J. ELITA. et al. Liver transplantation for neuroendocrine tumors in Europe-results and trends in patient selection: a 213-case European liver transplant registry study. Ann Surg 2013; 257: 807-815 DOI: 10.1097/SLA.0b013e31828ee17c. (PMID: 23532105)
- 34 Mazzaferro V, Sposito C, Coppa J. et al. The Long-Term Benefit of Liver Transplantation for Hepatic Metastases From Neuroendocrine Tumors. Am J Transplant 2016; 16: 2892-2902 DOI: 10.1111/ajt.13831. (PMID: 27134017)
- 35 Machairas N, Daskalakis K, Felekouras E. et al. Currently available treatment options for neuroendocrine liver metastases. Ann Gastroenterol 2021; 34: 130-141 DOI: 10.20524/aog.2021.0574. (PMID: 33654350)
- 36 Norlén O, Daskalakis K, Öberg K. et al. Indication for liver transplantation in young patients with small intestinal NETs is rare?. World J Surg 2014; 38: 742-747 DOI: 10.1007/s00268-013-2331-z. (PMID: 24233660)
- 37 Cazzato RL, Hubelé F, De Marini P. et al. Liver-Directed Therapy for Neuroendocrine Metastases: From Interventional Radiology to Nuclear Medicine Procedures. Cancers (Basel) 2021; 13: 6368 DOI: 10.3390/cancers13246368. (PMID: 34944988)
- 38 Zappa M, Abdel-Rehim M, Hentic O. et al. Liver-directed therapies in liver metastases from neuroendocrine tumors of the gastrointestinal tract. Target Oncol 2012; 7: 107-116 DOI: 10.1007/s11523-012-0219-8. (PMID: 22707276)
- 39 Akyildiz HY, Mitchell J, Milas M. et al. Laparoscopic radiofrequency thermal ablation of neuroendocrine hepatic metastases: long-term follow-up. Surgery 2010; 148: 1288-1293 DOI: 10.1016/j.surg.2010.09.014. (PMID: 21134563)
- 40 Kjaer J, Stålberg P, Crona J. et al. Long-term outcome after resection and thermal hepatic ablation of pancreatic neuroendocrine tumour liver metastases. BJS Open 2021; 5: zrab062 DOI: 10.1093/bjsopen/zrab062. (PMID: 34291287)
- 41 Spiliotis AE, Gäbelein G, Holländer S. et al. Microwave ablation compared with radiofrequency ablation for the treatment of liver cancer: a systematic review and meta-analysis. Radiol Oncol 2021; 55: 247-258 DOI: 10.2478/raon-2021-0030. (PMID: 34167181)
- 42 Perrodin SF, Renzulli MM, Maurer MH. et al. Can microwave ablation be an alternative to resection for the treatment of neuroendocrine liver metastases?. Endocr Pract 2020; 26: 378-387 DOI: 10.4158/EP-2019-0394. (PMID: 31859556)
- 43 Schippers AC, Collettini F, Steffen IG. et al. Initial Experience with CT-Guided High-Dose-Rate Brachytherapy in the Multimodality Treatment of Neuroendocrine Tumor Liver Metastases. J Vasc Interv Radiol 2017; 28: 672-682 DOI: 10.1016/j.jvir.2016.07.011. (PMID: 27645463)
- 44 Denecke T, Lopez Hänninen E. Brachytherapy of liver metastases. Recent Results Cancer Res 2008; 177: 95-104 DOI: 10.1007/978-3-540-71279-4_11. (PMID: 18084951)
- 45 Clift AK, Frilling A. Liver-Directed Therapies for Neuroendocrine Neoplasms. Curr Oncol Rep 2021; 23: 44 DOI: 10.1007/s11912-021-01030-0. (PMID: 33721122)
- 46 Pitt SC, Knuth J, Keily JM. et al. Hepatic neuroendocrine metastases: chemo- or bland embolization?. J Gastrointest Surg 2008; 12: 1951-1960 DOI: 10.1007/s11605-008-0640-6. (PMID: 18709512)
- 47 Del Prete M, Fiore F, Modica R. Multidisciplinary Group for NeuroEndocrine Tumors of Naples. et al. Hepatic arterial embolization in patients with neuroendocrine tumors. J Exp Clin Cancer Res 2014; 33: 43 DOI: 10.1186/1756-9966-33-43. (PMID: 24887262)
- 48 Riemsma RP, Bala MM, Wolff R. et al. Transarterial (chemo)embolisation versus no intervention or placebo intervention for liver metastases. Cochrane Database Syst Rev 2020; (03) CD009498 (PMID: 23633373)
- 49 Linch F, Thompson S, Fleming C. et al. Hepatic Artery Embolization for Palliation of Symptomatic Hypoglycemia in Patients With Hepatic Insulinoma Metastases. J Endocr Soc 2021; 5: bvab149 DOI: 10.1210/jendso/bvab149. (PMID: 34877442)
- 50 Starke A, Saddig C, Mansfeld L. et al. Malignant metastatic insulinoma-postoperative treatment and follow-up. World J Surg 2005; 29: 789-793 DOI: 10.1007/s00268-005-7743-y. (PMID: 15880279)
- 51 Barat M, Cottereau AS, Kedra A. et al. The Role of Interventional Radiology for the Treatment of Hepatic Metastases from Neuroendocrine Tumor: An Updated Review. J Clin Med 2020; 9: 2302 DOI: 10.3390/jcm9072302. (PMID: 32698459)
- 52 Yao JC, Shah MH, Ito T. RAD001 in Advanced Neuroendocrine Tumors, Third Trial (RADIANT-3) Study Group. et al. Everolimus for advanced pancreatic neuroendocrine tumors. N Engl J Med 2011; 364: 514-523 DOI: 10.1056/NEJMoa1009290. (PMID: 21306238)
- 53 Delaunoit T, Ducreux M, Boige V. et al. The doxorubicin-streptozotocin combination for the treatment of advanced well-differentiated pancreatic endocrine carcinoma; a judicious option?. Eur J Cancer 2004; 40: 515-520 DOI: 10.1016/j.ejca.2003.09.035. (PMID: 14962717)
- 54 Bodei L, Kwekkeboom DJ, Kidd M. et al. Radiolabeled Somatostatin Analogue Therapy Of Gastroenteropancreatic Cancer. Semin Nucl Med 2016; 46: 225-238 DOI: 10.1053/j.semnuclmed.2015.12.003. (PMID: 27067503)
- 55 Strosberg J, El-Haddad G, Wolin E. NETTER-1 Trial Investigators. et al. Phase 3 Trial of 177Lu-Dotatate for Midgut Neuroendocrine Tumors. N Engl J Med 2017; 376: 125-135 DOI: 10.1056/NEJMoa1607427. (PMID: 28076709)
- 56 Hicks RJ, Kwekkeboom DJ, Krenning E. Antibes Consensus Conference participants. et al. ENETS Consensus Guidelines for the Standards of Care in Neuroendocrine Neoplasia: Peptide Receptor Radionuclide Therapy with Radiolabeled Somatostatin Analogues. Neuroendocrinology 2017; 105: 295-309 DOI: 10.1159/000475526. (PMID: 28402980)
- 57 Shaheen S, Moradi F, Gamino G. et al. Patient Selection and Toxicities of PRRT for Metastatic Neuroendocrine Tumors and Research Opportunities. Curr Treat Options Oncol 2020; 21: 25 DOI: 10.1007/s11864-020-0711-9. (PMID: 32172368)
- 58 Kolasińska-Ćwikła A, Nowicki ML, Sankowski AJ. et al. Radiological and Clinical Efficacy of Intra-Arterial 90Y-DOTATATE in Patients with Unresectable, Progressive, Liver Dominant Neuroendocrine Neoplasms. J Clin Med 2021; 10: 1794 DOI: 10.3390/jcm10081794. (PMID: 33924160)