A RATIONAL APPROACH TO THE USE OF HEPATIC TRANSPLANTATION IN THE TREATMENT OF METASTATIC NEUROENDOCRINE TUMORS

BACKGROUND: Gastrointestinal neuroendocrine tumors are slow growing, a nd metastases are often limited to the liver. Whereas in asymptomatic patients, observation alone may be reasonable, in patients with neuroe ndocrine tumors and unresectable hepatic metastases, transplantation o f the liver may be beneficial. We have developed a protocol in which p atients with multiple hepatic metastases are initially treated with ch emotherapy and embolization to control symptoms and inhibit tumor grow th. Hepatic transplantation is reserved for patients in whom tumor pro gresses or symptoms of hormone production or mass effect persist. STUD Y DESIGN: This is a retrospective review of eight patients with neuroe ndocrine tumor metastases who were referred to the Mount Sinai Hospita l for evaluation for hepatic transplantation. RESULTS: Of the eight pa tients, three have undergone transplantation; all are alive, with no e vidence of tumor recurrence at 12 to 30 months. In two patients, sympt oms have been controlled by embolization of the hepatic artery or chem otherapy, or both; another has had massive hepatomegaly as a result of tumor progression, with wasting and portal hypertension, and currentl y awaits transplantation. Two patients died as a result of progressive disease, soon after referral. CONCLUSION: Transplantation of the live r may be an important treatment modality for a selected group of patie nts with neuroendocrine tumors unresponsive to conventional therapy.