The chief causes of death of patients with GEPNETs are liver failure from hepatic replacement by tumor in the majority and bowel obstruction in the remainder. Many patients are with liver metastases are actually eligible for hepatic cytoreductive operations, even if they have numerous bilobar metastases and extra-hepatic disease, provided that greater than 70% of the liver tumor volume can be removed. This can often be done by combinations of parenchyma-sparing enucleations, wedge resections and radio frequency ablations. Patients with higher liver tumor burden can be treated with intra-arterial therapies, such as embolization and chemoembolization. Patients with peritoneal carcinomatosis are recommended to undergo cytoreductive operations including peritoneal stripping and bowel resections. Consensus guidelines by experts recommend bisphosphonate therapy for patients with bone metastases, reserving surgical treatment for patients with mechanical issues and/or potential spinal cord compression. Radiation can be employed for isolated painful metastases. PRRT may be an emerging therapy for treatment of bone metastases.
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