Treatment of Small Intestine Neuroendocrine Tumour (Grade 1 or 2, Stage IV) with Exclusive Resectable Liver Metastases
This protocol addresses patients with a small intestine carcinoid (Si-NET) classified as grade 1 or grade 2 who present with stage IV disease in which the only site of metastatic spread is the liver — and where those liver metastases are considered resectable.
Clinical scenario
The patient has a grade 1 or grade 2 small intestine neuroendocrine tumour at stage IV. Thorough staging work-up — including MRI and functional imaging — has identified metastatic disease confined exclusively to the liver, with no extrahepatic tumour spread and no significant comorbidities precluding surgery. The key clinical question is whether a curative-intent surgical approach is appropriate.
Treatment approach (partial overview)
When R0 resection of the liver metastases can be achieved, the preferred approach is curative surgical intervention. For patients in whom peritoneal involvement is identified and is localised in extent, an additional surgical strategy targeting that component may also be considered.
Full regimen, sequencing, and decision criteria available via the protocol link below →
References
DOI: 10.1111/jne.13423
In patients with Si-NET G1/G2 stage IV disease and exclusive liver metastases a surgical approach is indicated, if R0 resection can be achieved (Recommendation B-4).
For Si-NET patients with resectable G1/G2 liver metastases without extrahepatic tumour spread identified after thorough work-up (including MRI as well as functional imaging) and with no significant comorbidities, a curative surgical approach is the treatment of choice.
Cytoreductive peritoneal surgery is recommended in patients with localised peritoneal carcinomatosis (Recommendation A-4).
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