Therapeutic alternatives in metastatic neuroendocrine tumors.

In the treatment of neuroendocrine tumors that cannot be resected for cure two goals must be addressed: (1) the control of symptoms related to hormonal hypersecretion and (2) the prolongation of survival by destruction of tumor of the limitation of its growth. Clinical approaches, medical and surgical, have been developed in recent years to meet these goals. Surgical options in the face of metastatic disease include resection of hepatic metastases, cryoablation, and liver transplantation. Medical therapy includes treatment of symptomatic hypersecretory states and systemic chemotherapeutic and immunomodulatory regimes. Hepatic artery chemoembolization has also been used successfully in the treatment of hepatic metastases of neuroendocrine tumors.