Treatment of Carcinoid of Small Intestine (G1/G2) with Predominant Liver Metastases in Non-Surgical Candidates
Clinical Scenario
This protocol applies to small intestine neuroendocrine tumour (Si-NET) grade 1 or grade 2 where the dominant disease burden is hepatic and the patient is not a candidate for surgical resection — whether due to performance status or the extent of liver involvement.
Patient Setting
In G1/G2 Si-NET with predominant liver metastases and no surgical option, liver-directed therapies are the recognised approach to achieve local tumour control. The goal is to reduce hepatic tumour burden at the dominant site of spread in patients who cannot undergo resection.
Treatment Approach (Partial Overview)
The protocol centres on liver-directed therapy, with the specific modality — either a percutaneous ablative technique or a transarterial approach — guided by defined characteristics of the hepatic metastases. Full selection criteria, procedural sequencing, and clinical decision points are available in the complete protocol.
References
DOI: 10.1111/jne.13423
- For patients with G1/G2 Si-NET with predominant liver metastases who are not surgical candidates due to either performance status or extent of liver disease, liver-directed therapies such as radiofrequency ablation (RFA), microwave ablation (MWA), irreversible electroporation (IRE), transarterial embolization (TAE), or chemoembolization (TACE) and radioembolization (TARE), can be applied to provide local tumour control and improve symptoms of CS.
- From a clinical point of view, percutaneous ablation techniques (RFA, MWA, IRE) are the treatments of choice in patients with oligometastatic disease (preferably maximum of 3–5 metastases and <3 cm in size) or oligoprogressive disease (1 or 2 metastases not responding to systemic treatment).
- For patients with metastases >3 cm, aforementioned risk factors for ablation or with multifocal uni- or bilobular disease, transarterial therapies such as TAE, TACE or TARE are usually indicated.
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