Combined Treatment of Patients with Neuroendocrine Liver Metastases Accompanied by High Hormonal Activity and Uncontrolled Carcinoid Syndrome

Introduction: The percentage of cases of neuroendocrine tumors (NET) is growing every year. Moreover, the diagnosis is often made in the later stages, when the disease manifests itself with manifestations of carcinoid syndrome (CS) and its accompanying indications. Today, there is a need to systematize approaches to diagnosis and individual groups of patients with unresectable metastatic lesions of NETs.
Material and methods: A retrospective assessment of the results of treatment of patients with bilobar metastatic liver disease NET on the background of uncontrolled CS was performed in the period from 2010 to 2023. The study included 10 patients with NET G1 — 4 patients, G2 — 6. The sampling structure according to the location of the primary lesion was divided into: pancreas (n = 7), small intestine (n = 3). Before the start of regional chemotherapy, the primary lesion was removed in 1 patient. The average age of the patients in the sample was 31.3 years.
In order to evaluate the results, patients underwent SCT of the abdominal cavity and chest with intravenous enhancement, PET/CT of the whole body with ⁶⁸Ga-DOTA TATE/NOC. All patients in the group received therapy with long-acting somatostatin analogues. Two of them additionally received everolimus 10 mg per day.
The leading method of embolization is oil TACE with a suspension of doxorubicin 50–100 mg or mitomycin C 10–20 mg with superfluid lipiodol 5–8 ml, then adding a collagen sponge 0.25–0.5 cm³ into the tumor vessels until blood flow is reduced. Courses were held once every 2 months. The evaluation of the treatment was carried out according to an objective examination (ECOG 0), the nature of the complaints, and instrumental diagnostic data (CT with intravenous contrast).
Results: Evaluation after regional chemotherapy: partial response in one patient; stabilization in seven; progression in two patients (according to mRECIST). The average serotonin level before CEPA was 936.5 ng/ml; after two courses there was a significant decrease to 282.1 ng/ml (p < 0.05). After stabilization of the disease, the primary lesion was removed in 6 patients; patients underwent cytoreductive atypical liver resection (n = 4) and MVA (n = 1). Currently, three patients have died, the average life expectancy of the deceased is 64 months. Seven patients were alive for periods ranging from 30 to 134 (median 84) months.
Conclusions : TACE in the treatment of patients with NETs that cause hyperproduction of hormones, manifested by CS and not relieved by somatostatin analogues, provides clinical and radiological improvements in 80 % of patients. Further cytoreductive interventions can extend the median overall-survival (OS) to 84 months.

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