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Current management strategies for neuroendocrine tumor hepatic metastases have relied on data from anecdotal evidence and retrospective studies involving small numbers of patients. It is unlikely that this situation will change in the near future, since prospective studies are difficult to perform in such a relatively rare and biologically heterogeneous disease. Embolotherapy is a widely accepted method of treatment for nonresectable hepatic metastases from neuroendocrine tumors. Long-term palliation of pain and hormonal symptoms is possible using repeated treatment. Both bland hepatic artery embolization and chemoembolization have been used, and there is no conclusive data to indicate which embolization method and which embolic agents are most efficacious.

PVE is a safe technique allowing efficient preoperative hypertrophy of the FRL in selected cases. It is recommended to perform distal embolization rather than proximal occlusion or ligation. Embolic agents producing high local inflammatory reaction induce greater hypertrophy than others do.

PVE neither improves nor worsens long-term prognosis but it allows curative resection in patients that otherwise are considered as unresectable. Nowadays, it may be frequently combined with multiple other efficient therapeutic modalities (systemic or intraarterial chemotherapy, chemoembolization, radiofrequency ablation) in order to lead more patients with malignant liver tumor to radical surgery.

Embolotherapy of small vessels in small patients needs well-trained pediatric radiologists and a dedicated environment. Networking between the few centers performing such procedures in children is paramount for continuously optimizing both their indications and their techniques, and for assessing their effectiveness.