Staged surgery with neoadjuvant 90Y-DOTATOC therapy for down-sizing synchronous bilobular hepatic metastases from a neuroendocrine pancreatic tumor.
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.
Stoeltzing
Oliver
O
Departments of Surgery and Surgical Oncology, University of Regensburg Medical Center, Franz-Josef-Strauss-Allee 11, 93042, Regensburg, Germany. oliver.stoeltzing@arcor.de
Loss
Martin
M
Huber
Elisabeth
E
Gross
Volker
V
Eilles
Christoph
C
Mueller-Brand
Jan
J
Schlitt
Hans J
HJ
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
C496730:90Y-octreotide, DOTA-Tyr(3)-; D015282:Octreotide