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liver-directed therapies for liver metastases from neuroendocrine neoplasms:Can laser ablation play any role?

World Journal of Gastroenterology 2020年第23期26卷 3118-3125页

作者： Sergio Sartori Lara Bianchi Francesca Di Vece Paola Tombesi Department of Internal Medicine Section of Interventional UltrasoundSt.Anna HospitalFerrara 44100Italy

Aggressive cytoreduction can prolong survival in patients with unresectable liver metastases(LM)from neuroendocrine neoplasms(NEN),and minimally invasive,liver-directed therapies are gaining increasing interest.Catheter-based treatments are used in disseminated disease,whereas ablation techniques are usually indicated when the number of LM is limited.Although radiofrequency ablation(RFA)is by far the most used ablative technique,the goal of this opinion review is to explore the potential role of laser ablation(LA)in the treatment of LM from NEN.LA uses thinner needles than RFA,and this is an advantage when the tumors are in at-risk locations.Moreover,the multi-fiber technique enables the use of one to four laser fibers at once,and each fiber provides an almost spherical thermal lesion of 12-15 mm in diameter.Such a characteristic enables to tailor the size of each thermal lesion to the size of each tumor,sparing the liver parenchyma more than any other liver-directed therapy,and allowing for repeated treatments with low risk of liver failure.A recent retrospective study reporting the largest series of LM treated with LA documents both safety and effectiveness of LA,that can play a useful role in the multimodality approach to LM from NEN.

关键词： Neuroendocrine neoplasms liver metastases liver-directed therapies Ablation techniques Laser ablation Radiofrequency ablation

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Neuroendocrine liver metastases: a contemporary review of treatment strategies

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Hepatobiliary Surgery and Nutrition 2020年第4期9卷 440-451页

作者： Jordan M.Cloyd Aslam Ejaz Bhavana Konda Mina S.Makary Timothy M.Pawlik Departments of Surgery The Ohio State UniversityWexner Medical CenterColumbusOHUSA Departments of Internal Medicine The Ohio State UniversityWexner Medical CenterColumbusOHUSA Departments of Radiology The Ohio State UniversityWexner Medical CenterColumbusOHUSA

Well-differentiated neuroendocrine tumors(NETs)are globally increasing in prevalence and the liver is the most common site of metastasis.Neuroendocrine liver metastases(NELM)are heterogeneous in clinical presentation and prognosis.Fortunately,recent advances in diagnostic techniques and therapeutic strategies have improved the multidisciplinary management of this challenging condition.When feasible,surgical resection of NELM offers the best long-term outcomes.General indications for hepatic resection include performance status acceptable for major liver surgery,grade 1 or 2 tumors,absence of extrahepatic disease,adequate size and function of future liver remnant,and feasibility of resecting>90%of metastases.Adjunct therapies including concomitant liver ablation are generally safe when used appropriately and may expand the number of patients eligible for surgery.Among patients with synchronous resectable NELM,resection of the primary either in a staged or combined fashion is recommended.For patients who are not surgical candidates,liver-directed therapies such as transarterial embolization,chemoembolization,and radioembolization can provide locoregional control and improve symptoms of carcinoid syndrome.Multiple systemic therapy options also exist for patients with advanced or progressive disease.Ongoing research efforts are needed to identify novel biomarkers that will define the optimal indications for and sequencing of treatments to be delivered in a personalized fashion.

关键词： Gastroenteropancreatic neuroendocrine tumors(GEP-NETs) liver-directed therapies carcinoid hepatic resection targeted therapy

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