Minimally invasive techniques in management of hepatic neuroendocrine metastatic disease

David M. Liu, Andrew Kennedy, David Turner, Steven C. Rose, Stephen T. Kee, Samuel Whiting, Ravi Murthy, Charles Nutting, Manraj Heran, Robert J Lewandowski, Jesse Knight, Seza Gulec, Riad Salem

Research output: Contribution to journalReview article

22 Citations (Scopus)

Abstract

The development of new technologies and therapies provides an exciting new chapter in the management of neuroendocrine disease. Fundamentally (albeit through an extensive array of retrospectively based studies), the use of cytoreductive therapies (whether it be through open surgery, laparoscopic approaches, percutaneous, or endovascular) have clearly demonstrated the ability to control symptoms, decrease tumor burden, and in selected series, translate into survival benefit. However, this situation is not without challenge, as overall strategy and consensus has not been reached as to the optimal therapy. In general, local regional therapy for hepatic metastatic disease should begin with the decision of the intent to treat. Transplant (which, at present has a very limited role), surgical resection, and ablative therapies, such as RF, cryoablation, and microwave provide (in these circumstances) the only options for 100% destruction of macroscopic disease (ie, that disease burden that is visualized by current imaging technology), assuming that the primary tumor has been removed or resected. Endovascular methods may have the ability to treat microscopic disease, however, is considered palliative, as the entire disease burden may not be fully addressed. One potential advantage of endovascular therapy (and in particular Y-90 radioembolization) is to provide the possibility to downstage (shrink) disease to resection or ablation, while providing cytoreduction. Although not discussed in this forum, systemic therapeutic options also offer much promise, and readers are encouraged to examine the current literature in this regard. A summary of recent published literature concerning response and applications of systemic chemotherapy (Table 1) and systemic radiotherapy is provided for review (Table 4). With the advancement of local regional disease management through medical, surgical, and radiologic methods, a multidisciplinary approach must be implemented to prospectively develop treatment algorithms and draw from the expertise and experience of each discipline. The current challenges facing the medical and patient community are deciding what the best-suited therapy is for an individual, given the state of the art. No therapy is without inherent risk, and thus the second consideration, the risk to benefit ratio must also be discussed. Simply put, it must be ensured that the benefit derived from the procedure or intervention must outweigh the risk, effect on quality of life, and the potential of effecting other therapeutic options.

Original languageEnglish (US)
Pages (from-to)200-215
Number of pages16
JournalAmerican Journal of Clinical Oncology: Cancer Clinical Trials
Volume32
Issue number2
DOIs
StatePublished - Apr 1 2009

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Liver
Therapeutics
Disease Management
Technology
Cryosurgery
Microwaves
Tumor Burden
Laparoscopy
Radiotherapy
Quality of Life
Transplants
Drug Therapy
Neoplasms

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Liu, David M. ; Kennedy, Andrew ; Turner, David ; Rose, Steven C. ; Kee, Stephen T. ; Whiting, Samuel ; Murthy, Ravi ; Nutting, Charles ; Heran, Manraj ; Lewandowski, Robert J ; Knight, Jesse ; Gulec, Seza ; Salem, Riad. / Minimally invasive techniques in management of hepatic neuroendocrine metastatic disease. In: American Journal of Clinical Oncology: Cancer Clinical Trials. 2009 ; Vol. 32, No. 2. pp. 200-215.
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abstract = "The development of new technologies and therapies provides an exciting new chapter in the management of neuroendocrine disease. Fundamentally (albeit through an extensive array of retrospectively based studies), the use of cytoreductive therapies (whether it be through open surgery, laparoscopic approaches, percutaneous, or endovascular) have clearly demonstrated the ability to control symptoms, decrease tumor burden, and in selected series, translate into survival benefit. However, this situation is not without challenge, as overall strategy and consensus has not been reached as to the optimal therapy. In general, local regional therapy for hepatic metastatic disease should begin with the decision of the intent to treat. Transplant (which, at present has a very limited role), surgical resection, and ablative therapies, such as RF, cryoablation, and microwave provide (in these circumstances) the only options for 100{\%} destruction of macroscopic disease (ie, that disease burden that is visualized by current imaging technology), assuming that the primary tumor has been removed or resected. Endovascular methods may have the ability to treat microscopic disease, however, is considered palliative, as the entire disease burden may not be fully addressed. One potential advantage of endovascular therapy (and in particular Y-90 radioembolization) is to provide the possibility to downstage (shrink) disease to resection or ablation, while providing cytoreduction. Although not discussed in this forum, systemic therapeutic options also offer much promise, and readers are encouraged to examine the current literature in this regard. A summary of recent published literature concerning response and applications of systemic chemotherapy (Table 1) and systemic radiotherapy is provided for review (Table 4). With the advancement of local regional disease management through medical, surgical, and radiologic methods, a multidisciplinary approach must be implemented to prospectively develop treatment algorithms and draw from the expertise and experience of each discipline. The current challenges facing the medical and patient community are deciding what the best-suited therapy is for an individual, given the state of the art. No therapy is without inherent risk, and thus the second consideration, the risk to benefit ratio must also be discussed. Simply put, it must be ensured that the benefit derived from the procedure or intervention must outweigh the risk, effect on quality of life, and the potential of effecting other therapeutic options.",
author = "Liu, {David M.} and Andrew Kennedy and David Turner and Rose, {Steven C.} and Kee, {Stephen T.} and Samuel Whiting and Ravi Murthy and Charles Nutting and Manraj Heran and Lewandowski, {Robert J} and Jesse Knight and Seza Gulec and Riad Salem",
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Liu, DM, Kennedy, A, Turner, D, Rose, SC, Kee, ST, Whiting, S, Murthy, R, Nutting, C, Heran, M, Lewandowski, RJ, Knight, J, Gulec, S & Salem, R 2009, 'Minimally invasive techniques in management of hepatic neuroendocrine metastatic disease', American Journal of Clinical Oncology: Cancer Clinical Trials, vol. 32, no. 2, pp. 200-215. https://doi.org/10.1097/COC.0b013e318172b3b6

Minimally invasive techniques in management of hepatic neuroendocrine metastatic disease. / Liu, David M.; Kennedy, Andrew; Turner, David; Rose, Steven C.; Kee, Stephen T.; Whiting, Samuel; Murthy, Ravi; Nutting, Charles; Heran, Manraj; Lewandowski, Robert J; Knight, Jesse; Gulec, Seza; Salem, Riad.

In: American Journal of Clinical Oncology: Cancer Clinical Trials, Vol. 32, No. 2, 01.04.2009, p. 200-215.

Research output: Contribution to journalReview article

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T1 - Minimally invasive techniques in management of hepatic neuroendocrine metastatic disease

AU - Liu, David M.

AU - Kennedy, Andrew

AU - Turner, David

AU - Rose, Steven C.

AU - Kee, Stephen T.

AU - Whiting, Samuel

AU - Murthy, Ravi

AU - Nutting, Charles

AU - Heran, Manraj

AU - Lewandowski, Robert J

AU - Knight, Jesse

AU - Gulec, Seza

AU - Salem, Riad

PY - 2009/4/1

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N2 - The development of new technologies and therapies provides an exciting new chapter in the management of neuroendocrine disease. Fundamentally (albeit through an extensive array of retrospectively based studies), the use of cytoreductive therapies (whether it be through open surgery, laparoscopic approaches, percutaneous, or endovascular) have clearly demonstrated the ability to control symptoms, decrease tumor burden, and in selected series, translate into survival benefit. However, this situation is not without challenge, as overall strategy and consensus has not been reached as to the optimal therapy. In general, local regional therapy for hepatic metastatic disease should begin with the decision of the intent to treat. Transplant (which, at present has a very limited role), surgical resection, and ablative therapies, such as RF, cryoablation, and microwave provide (in these circumstances) the only options for 100% destruction of macroscopic disease (ie, that disease burden that is visualized by current imaging technology), assuming that the primary tumor has been removed or resected. Endovascular methods may have the ability to treat microscopic disease, however, is considered palliative, as the entire disease burden may not be fully addressed. One potential advantage of endovascular therapy (and in particular Y-90 radioembolization) is to provide the possibility to downstage (shrink) disease to resection or ablation, while providing cytoreduction. Although not discussed in this forum, systemic therapeutic options also offer much promise, and readers are encouraged to examine the current literature in this regard. A summary of recent published literature concerning response and applications of systemic chemotherapy (Table 1) and systemic radiotherapy is provided for review (Table 4). With the advancement of local regional disease management through medical, surgical, and radiologic methods, a multidisciplinary approach must be implemented to prospectively develop treatment algorithms and draw from the expertise and experience of each discipline. The current challenges facing the medical and patient community are deciding what the best-suited therapy is for an individual, given the state of the art. No therapy is without inherent risk, and thus the second consideration, the risk to benefit ratio must also be discussed. Simply put, it must be ensured that the benefit derived from the procedure or intervention must outweigh the risk, effect on quality of life, and the potential of effecting other therapeutic options.

AB - The development of new technologies and therapies provides an exciting new chapter in the management of neuroendocrine disease. Fundamentally (albeit through an extensive array of retrospectively based studies), the use of cytoreductive therapies (whether it be through open surgery, laparoscopic approaches, percutaneous, or endovascular) have clearly demonstrated the ability to control symptoms, decrease tumor burden, and in selected series, translate into survival benefit. However, this situation is not without challenge, as overall strategy and consensus has not been reached as to the optimal therapy. In general, local regional therapy for hepatic metastatic disease should begin with the decision of the intent to treat. Transplant (which, at present has a very limited role), surgical resection, and ablative therapies, such as RF, cryoablation, and microwave provide (in these circumstances) the only options for 100% destruction of macroscopic disease (ie, that disease burden that is visualized by current imaging technology), assuming that the primary tumor has been removed or resected. Endovascular methods may have the ability to treat microscopic disease, however, is considered palliative, as the entire disease burden may not be fully addressed. One potential advantage of endovascular therapy (and in particular Y-90 radioembolization) is to provide the possibility to downstage (shrink) disease to resection or ablation, while providing cytoreduction. Although not discussed in this forum, systemic therapeutic options also offer much promise, and readers are encouraged to examine the current literature in this regard. A summary of recent published literature concerning response and applications of systemic chemotherapy (Table 1) and systemic radiotherapy is provided for review (Table 4). With the advancement of local regional disease management through medical, surgical, and radiologic methods, a multidisciplinary approach must be implemented to prospectively develop treatment algorithms and draw from the expertise and experience of each discipline. The current challenges facing the medical and patient community are deciding what the best-suited therapy is for an individual, given the state of the art. No therapy is without inherent risk, and thus the second consideration, the risk to benefit ratio must also be discussed. Simply put, it must be ensured that the benefit derived from the procedure or intervention must outweigh the risk, effect on quality of life, and the potential of effecting other therapeutic options.

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