The Role of Liver Transplantation in the Treatment of Liver Metastases from Neuroendocrine Tumors.
Davide CitterioJorgelina CoppaCarlo SpositoMichele Droz Dit BussetMatteo VirdisIsabella PezzoliVincenzo MazzaferroPublished in: Current treatment options in oncology (2023)
Transplant oncology is a new field of medicine referred to the use of solid organ transplantation, particularly the liver, to improve prognosis and quality of life in cancer patients. In unresectable, liver-only metastases from neuroendocrine tumors (NETs) of the digestive tract, liver transplantation represents a competitive chance of cure. Due to the limited resource of donated organs, accurate patients' selection is crucial in order to maximize transplant benefit. Several tumor- and patient-related factors should be considered. Among them, primary tumors with a low grade of differentiation (G1-G2 or Ki67 < 10%), located in a region drained by the portal system and removed before transplantation with at least 3-6 months period of disease stability observed before transplant listing, can be considered for transplantation. In case of NET located in the pancreas, extended lymphadenectomy should complement curative pancreatic resection. A number of other features are described in this review of liver transplantation for NET metastases. Comprehensive approach including various forms of non-surgical treatment and detailed planning and timing of total hepatectomy are discussed. Open issues remain on possible expansion of current criteria while maintaining the same long-term benefit demonstrated with the Milan NET criteria with respect to other non-transplant options, with particular reference to liver resection, peptide receptor radionuclide therapy, and locoregional and systemic treatments.
Keyphrases
- neuroendocrine tumors
- liver metastases
- low grade
- end stage renal disease
- high grade
- cell therapy
- prognostic factors
- chronic kidney disease
- newly diagnosed
- early stage
- ejection fraction
- minimally invasive
- peritoneal dialysis
- stem cells
- lymph node metastasis
- patient reported
- neoadjuvant chemotherapy
- mass spectrometry
- radiation therapy
- drug induced