NEN: Advancement in Diagnosis and Minimally Invasive Therapy

Abstract

Neuroendocrine neoplasms (NEN) are a heterogeneous type of malignant disease and frequently present with symptoms caused by the secretion of metabolically active substances or the manifestation of distant metastases, with the liver being the most frequent site of spreading. Early diagnosis of metastatic disease is recognized as the major prognostic factor in NEN patients. Complete surgical resection is feasible in only selected cases. For patients with unresectable liver metastases, various locoregional treatment approaches are available. Over the last decade, therapeutic procedures including locoregional and systemic treatments have been investigated for gastroenteropancreatic NEN (GEP-NEN), especially for metastatic disease to the liver. Only a few prospective clinical trials have compared these approaches, and the management of individual patients remains subject to clinical expertise and judgement. Locoregional treatments are applicable in patients with limited metastatic involvement of the liver, and may be used for tumor debulking and symptom control in patients with diffuse liver involvement.

Key Points:

• Neuroendocrine Neoplasms (NENs) represent a heterogeneous class of rare malignancies.

• Surgery is the treatment of choice for primary non-metastatic NEN.

• The liver is the most frequently affected site by neuroendocrine metastases.

• In limited metastastic liver disease local curative treatment may be accomplished by surgical resection or percutaneous thermal ablation.

• Multi-probe stereotactic thermal ablation with image fusion for intraoperative evaluation of a sufficient safety margin allows for safe and effective treatment of large liver metastases.

Citation Format

• Putzer D, Schullian P, Jaschke W et al. NET: Neue Entwicklungen in Diagnostik und minimalinvasiver Therapie. Fortschr Röntgenstr 2020; 192: 422 – 430

Zusammenfassung

Neuroendokrine Tumoren (NET) bilden eine heterogene Entität maligner Erkrankungen und werden häufig durch Symptome manifest, die durch die Ausscheidung metabolisch aktiver Substanzen oder durch Fernmetastasen hervorgerufen werden, wobei Metastasen der Leber häufig auftreten. Die frühzeitige Diagnose einer metastasierten Erkrankung gilt als der wichtigste Prognosefaktor für NET-Patienten. Eine vollständige chirurgische Resektion ist nur in ausgewählten Fällen möglich. Für Patienten mit nicht resezierbaren Lebermetastasen stehen verschiedene lokoregionäre Behandlungsansätze zur Verfügung. In den letzten zehn Jahren wurden therapeutische Verfahren einschließlich lokoregionärer und systemischer Behandlungen für gastroenteropankreatische NET (GEP-NET), insbesondere für Lebermetastasen, untersucht. Nur wenige prospektive klinische Studien zielen darauf ab, diese Ansätze zu vergleichen, und das Management einzelner Patienten unterliegt weiterhin klinischem Fachwissen und Urteilsvermögen. Lokal ablative Verfahren stellen ein effektives therapeutisches Verfahren für Patienten dar, die einem kurativen Therapieansatz zugänglich sind, und können ebenso zur Tumorreduktion und Symptomkontrolle bei Patienten mit multifokaler Metastasierung der Leber verwendet werden.

Kernaussagen:

• Neuroendokrine Neoplasien (NENs) sind eine heterogene Gruppe von seltenen Malignomen.

• Bei primären nicht metastasierten NENs gilt die chirurgische Resektion als Therapie der ersten Wahl.

• Metastasen von neuroendokrinen Tumoren befallen am häufigsten die Leber.

• Eine limitierte Lebermetastasierung kann mittels chirurgischer Resektion oder thermischer Ablation mit kurativer Zielsetzung behandelt werden.

• Die stereotaktische thermische Ablation mit multiplen Nadeln und Bildfusion zur intraoperativen Kontrolle eines ausreichenden Sicherheitssaums erlaubt eine sichere und effektive Behandlung von großen Lebermetastasen.

Key words

neuroendocrine tumor imaging - locoregional treatment - percutaneous ablation - stereotactic radiofrequency ablation (SRFA) - minimally invasive therapy

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