Neuroendocrine tumors (NETs) comprise a heterogeneous group of tumors that form a distinct entity. Approximately 75–80% of patients present with liver metastases at the time of their diagnosis, and 20%–25% will develop these lesions in the course of their disease. The presence of secondary deposits in the liver significantly increases the morbidity and mortality in these patients. The only potentially curative treatment is the surgical resection of the primary tumor and hepatic lesions. However, only 10% of patients presents under ideal conditions for that approach. Several techniques aimed at localized liver lesions have been applied also with interesting results in terms of survival and symptom control. The same has been demonstrated with new systemic therapies (target therapies). However, these are still under study, in order to define their true role in the management of these patients. This paper intends to address, in a general way, the various treatment options in patients with liver metastases from neuroendocrine tumors. 1. Introduction The neuroendocrine tumors (NETs) are a heterogeneous group of neoplasms that share some biological characteristics, that have been addressed as a common entity [1]. In 62%–82% of the cases, the NETs are located in the digestive system, being designated as gastroenteropancreatic neuroendocrine tumors (GEP-NETs) [2]. The latest figures from the UK, Sweden, and Switzerland suggested that their incidence is 2-3/100000 with a higher prevalence in females [1]. Also data from the Surveillance, Epidemiology, and End Results (SEER) Program Database report an increased incidence between 1973 and 2004 of 1.09 to 5,25/100000 [3, 4]. NETs are classically characterized by their ability to secrete hormones and/or vasoactive peptides, which results in many of their clinical manifestations, ganging up on specific hormonal syndromes. The most frequent syndrome is the carcinoid syndrome, which results from the secretion of serotonin and includes symptoms such as skin flushing, severe diarrhea, abdominal cramping, and electrolyte abnormalities [4, 5]. Their clinical course is variable, having been considered traditionally with an indolent natural history [1, 4]. However, some NETs have aggressive behavior regarding the rapid progression of metastatic lesions. All of them have the potential of metastatic dissemination and, therefore, are currently recognized as malignant neoplasms [6]. The prognosis and the approach of NETs are guided mainly according to the histological classification. The tumors with grade 3, mitotic count
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