A large proportion of patients with midgut and hindgut NETs (up to 60%–75%) present with liver metastases. A wide range of options are available to manage these patients. Possibilities include surgical, medical, radiologic, and nuclear medicine methods.1
The wide range of modalities listed above underlines the need for a multidisciplinary approach involving oncologists, pathologists, radiologists, surgeons, and others.1 If surgery is not an option, two commonly used techniques are:
Radiofrequency ablation
Radiofrequency ablation (RFA) can be effective in both relieving the symptoms of NET liver metastases and achieving local control of metastases. RFA has become available in many medical centers. Both percutaneous and laparoscopic applications of RFA are used depending on the location and extent of metastatic spread.1
However, RFA can be problematic to employ near vital structures or at the surface of the liver in close proximity to the stomach, colon, or diaphragm. In most cases, a tumor >5 cm in diameter is considered to be unsuitable for RFA.1
Hepatic embolization
Selective hepatic transcatheter arterial embolization (TAE) or chemoembolization (TACE) with hepatic artery occlusion can be employed in the management of liver metastases in appropriate patients. The goal of this intervention is to reduce neoplasm size and hormone output. Arterial embolization induces ischemia of the tumor cells, thereby reducing their hormone output.2
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