Endocrine Abstracts

Introduction: Majority of patients with neuroendocrine tumors (NET) harbor hepatic metastases at presentation, posing therapeutic challenge. Multiple liver-directed treatment modalities have been employed with variable success. Herein is presented successful outcome in a patient whose recurrent metastatic liver metastases from NET was managed using multidisciplinary approach.

Case report: We present long-term18-years course of a patient with liver metastases from midgut carcinoid. She had successful outcome using repeated surgery, radiofrequency ablation, octreotide, and therasphere therapy in succession. Minimally invasive therapy of therasphere using transarterial yettrium 90 can be used safely for recurrent hepatic metastatic neuroendocrine tumor.

A 61-year old female with hepatic metastases from non-functioning jejunal carcinoid had resection of 25 cm of small bowel containing 5 cm of carcinoid tumor, resection of 5 cm mesenteric metastatic lymph node, resection of hepatic segments 3 and 4 containing the tumor measuring 7.5 cm. This was followed 10 years later by resection and radioablation of recurrent hepatic metastases. Two years later MRI and octreoscan revealed multiple liver metastases, with abnormal circulating CGA (100 ng/ml; Ref. <93) and received on going monthly octreotide injections. Four years later liver metastases progresses with additional lesions. Liver biopsy revealed metastatic neuroendocrine grade 2 tumor (Ki-67 index 4.5%). In view of her diabetes PRRT was not given; instead she received therasphere therapy. 90 yttrium, tumor dose 164 Gy was injected into left hepatic artery. Patient tolerated it well with no side effects. A year later MRI showed resolution of tumor with atrophic left lobe, and hypertrophic right lobe.

Conclusion: Majority of patients with neuroendocrine tumors present with liver metastases. Despite therapeutic challenge; hepatic metastases can be managed by a combination of surgical, radioablation, medical and radioembolization therapy using Yttrium 90.