Opinion statement

The treatment of neuroendocrine neoplasm (NEN) liver metastases involves a multidisciplinary approach that includes liver-directed therapies (LDT) and systemic treatments, such as peptide receptor radionuclide therapy (PRRT). LDT has demonstrated efficacy in rapidly reducing tumor bulk, improving symptoms, and delaying disease progression. Interventional radiologists should be consulted prior to switching therapy for patients with progressive or symptomatic neuroendocrine tumor liver metastases. Long-term follow-up data on the safety of Yttrium-90 radioembolization before and after PRRT remain limited. Therefore, a more conservative approach may be to preferentially employ transarterial embolization (TAE) or transarterial chemoembolization (TACE) for patients’ somatostatin receptor-avid disease who may be future candidates for PRRT. Notable exceptions where radioembolization may be a preferred treatment strategy may be patients with history of biliary tract instrumentation, asymmetric unilobar disease distribution, and rapidly progressive diffuse liver involvement. Selection of local treatment modality, sequencing, and combination of LDT with systemic therapy require further investigation.

中文翻译：

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肽受体放射性核素治疗时代神经内分泌肿瘤转移的肝脏定向治疗

 意见陈述

神经内分泌肿瘤（NEN）肝转移的治疗涉及多学科方法，包括肝脏定向治疗（LDT）和全身治疗，例如肽受体放射性核素治疗（PRRT）。 LDT 已被证明可以有效减少肿瘤体积、改善症状和延缓疾病进展。对于进行性或有症状的神经内分泌肿瘤肝转移患者，在转换治疗之前应咨询介入放射科医生。 PRRT 前后钇 90 放射栓塞安全性的长期随访数据仍然有限。因此，更保守的方法可能是优先采用经动脉栓塞（TAE）或经动脉化疗栓塞（TACE）治疗生长抑素受体旺盛的疾病，这些患者可能是未来 PRRT 的候选者。放射栓塞可能是首选治疗策略的显着例外可能是有胆道器械使用史、不对称单叶疾病分布和快速进展性弥漫性肝脏受累的患者。局部治疗方式的选择、排序以及 LDT 与全身治疗的结合需要进一步研究。