Veenendaal Liesbeth M, Borel Rinkes Inne H M, Lips Cornelis J M, van Hillegersberg Richard
Department of Surgery, University Medical Center Utrecht, The Netherlands.
World J Surg Oncol. 2006 Jun 26;4:35. doi: 10.1186/1477-7819-4-35.
Neuroendocrine tumours frequently metastasize to the liver. Although generally slowly progressing, hepatic metastases are the major cause of carcinoid syndrome and ultimately lead to liver dysfunction, cardiac insufficiency and finally death.
A literature review was performed to define the optimal treatment strategy and work-up in patients with neuroendocrine hepatic metastases. Based on this, an algorithm for the management of these patients was established.
Platelet serotonin and chromogranin A are useful biomarkers for detection and follow-up of neuroendocrine tumour. Helical computed tomography and somatostatin receptor scintigraphy are the most sensitive diagnostic modalities. Surgical debulking is an accepted approach for reducing hormonal symptoms and to establish better conditions for medical treatment, but is frequently impossible due to the extent of disease. A novel approach is the local ablation of tumour by thermal coagulation using therapies such as radiofrequency ablation (RFA) or laser induced thermotherapy (LITT). These techniques preserve normal liver tissue. There is a tendency to destroy metastases early in the course of disease, thereby postponing or eliminating the surgically untreatable stage. This can be combined with postoperative radioactive octreotide to eliminate small multiple metastases. In patients with extensive metastases who are not suitable for local destruction, systemic therapy by octreotide, 131I-MIBG treatment or targeted chemo- and radiotherapy should be attempted. A final option for selective patients is orthotopic liver transplantation.
Treatment for patients with neuroendocrine hepatic metastases must be tailored for each individual patient. When local ablative therapies are used early in the course of the disease, the occurrence of carcinoid syndrome with end stage hepatic disease can be postponed or prevented.
神经内分泌肿瘤常转移至肝脏。尽管通常进展缓慢，但肝转移是类癌综合征的主要原因，最终会导致肝功能障碍、心脏功能不全并最终死亡。
进行文献综述以确定神经内分泌肝转移患者的最佳治疗策略及检查方法。在此基础上，建立了此类患者的管理算法。
血小板5-羟色胺和嗜铬粒蛋白A是神经内分泌肿瘤检测及随访的有用生物标志物。螺旋计算机断层扫描和生长抑素受体闪烁扫描是最敏感的诊断方式。手术减瘤是减轻激素症状及为药物治疗创造更好条件的一种公认方法，但由于疾病范围，常常无法实施。一种新方法是使用射频消融（RFA）或激光诱导热疗（LITT）等热凝疗法对肿瘤进行局部消融。这些技术可保留正常肝组织。存在在疾病进程早期破坏转移灶的趋势，从而推迟或消除手术无法治疗的阶段。这可与术后放射性奥曲肽联合使用以消除小的多发转移灶。对于广泛转移且不适合局部破坏的患者，应尝试使用奥曲肽进行全身治疗、131I-MIBG治疗或靶向化疗及放疗。对于部分选择性患者，最终选择是原位肝移植。
神经内分泌肝转移患者的治疗必须针对每个患者量身定制。在疾病进程早期使用局部消融疗法时，可推迟或预防类癌综合征伴终末期肝病的发生。
