Hepatic
metastases are frequently encountered in patients with digestive endocrine
tumors and their presence plays an important role in quality of life and overall prognosis. Surgery is the treatment method of choice for hepatic
metastases but this is frequently impossible due to the extent of disease. Systemic
chemotherapy is offered to patients with diffuse and/or progressive liver
metastases but results are disappointing especially in patients with
metastases of midgut origin. In the latter patients with
carcinoid syndrome,
somatostatin analogs are frequently initially effective but their efficacy wanes due to
disease progression and development of tachyphylaxis. Other therapeutic options in the treatment of hepatic
metastases are locoregional strategies where vascular occlusion induces
ischemia in these highly vascular
tumors using either surgical or radiological techniques. Available methods include surgical
ligation of the hepatic artery, transient hepatic
ischemia or sequential hepatic arterialization. Trans-
catheter arterial chemoembolization has proven effective in terms of long palliation and objective
tumor responses. Other treatments aimed at regional destruction either alone or in combination with surgery include
radiofrequency ablation and
cryotherapy. The latter are usually important adjuncts to surgery and are usually reserved for limited disease.