title: Staged surgery with neoadjuvant 90Y-DOTATOC therapy for down-sizing synchronous bilobular hepatic metastases from a neuroendocrine pancreatic tumor.
abstract: OBJECTIVE
  Treatment with DOTA-d-Phe(1)-Tyr(3)-octreotide (DOTATOC), labeled with beta-emitting radioisotope yttrium-90 ((90)Y-DOTATOC), has successfully been used for the palliative treatment of patients with advanced somatostatin receptor-expressing neuroendocrine tumors (NETs). However, controversy persists as to whether patients with metastatic NETs of the pancreas should undergo radical (salvage) surgery or receive palliative therapy. We proposed that (90)Y-DOTATOC could be used in a neoadjuvant intention for improving therapy of hepatic NET metastases.
  
  
  METHODS
  We investigated a novel therapy concept in a 49-year-old patient presenting with a neuroendocrine tumor of the pancreatic tail and synchronous multiple bilobular hepatic metastases. After surgical removal of the large primary tumor by extended left en bloc resection of the pancreatic tail, the patient received neoadjuvant (90)Y-DOTATOC for therapy of primarily non-resectable bilobular hepatic metastases.
  
  
  RESULTS
  The (90)Y-DOTATOC therapy resulted in an impressive regression of hepatic lesions, thus facilitating surgical removal of all remaining liver metastases in a second operation (staged surgery). In addition, one lesion was ablated using radiofrequency ablation (RFA). At 1-year of follow-up after hepatic R0 resection/RFA, there was no evidence of tumor recurrence or extrahepatic metastasis.
  
  
  CONCLUSIONS
  The neoadjuvant use of (90)Y-DOTATOC therapy could prove valuable for treatment of advanced pancreatic NETs metastatic to the liver in terms of facilitating R0 resection by applying staged surgery concepts.
authors.affiliation: Departments of Surgery and Surgical Oncology, University of Regensburg Medical Center, Franz-Josef-Strauss-Allee 11, 93042, Regensburg, Germany. oliver.stoeltzing@arcor.de
authors.forename: Oliver
authors.initials: O
authors.lastname: Stoeltzing
authors.forename: Martin
authors.initials: M
authors.lastname: Loss
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Huber
authors.forename: Volker
authors.initials: V
authors.lastname: Gross
authors.forename: Christoph
authors.initials: C
authors.lastname: Eilles
authors.forename: Jan
authors.initials: J
authors.lastname: Mueller-Brand
authors.forename: Hans J
authors.initials: HJ
authors.lastname: Schlitt
mesh_terms: D001707:Biopsy, Needle; D017115:Catheter Ablation; D006498:Hepatectomy / Q000379:methods; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis / Q000556:secondary / Q000628:therapy*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods*; D018358:Neuroendocrine Tumors / Q000175:diagnosis / Q000556:secondary / Q000628:therapy*; D015282:Octreotide / Q000031:analogs & derivatives* / Q000627:therapeutic use; D010166:Palliative Care; D010180:Pancreatectomy / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000473:pathology*; D049268:Positron-Emission Tomography; D012074:Remission Induction; D016879:Salvage Therapy; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: C496730:90Y-octreotide, DOTA-Tyr(3)-; D015282:Octreotide