Neoadjuvant Treatment of Nonfunctioning Pancreatic Neuroendocrine Tumors with [177Lu-DOTA0,Tyr3]Octreotate.
Pancreatic neuroendocrine tumors (NETs) are rare neoplasms for which surgery has almost the only potential for cure. When surgery is not possible because of tumor size and vascular involvement, neoadjuvant treatment with [(177)Lu-DOTA(0),Tyr(3)]octreotate ((177)Lu-octreotate) may be an option.


METHODS
We studied 29 Dutch patients with a pathology-proven nonfunctioning pancreatic NET treated with (177)Lu-octreotate. All patients had a borderline or unresectable pancreatic tumor (group 1) or oligometastatic disease (defined as ≤3 liver metastases) (group 2). Progression-free survival (PFS) was analyzed using the Kaplan-Meier method and Cox proportional hazards modeling.


RESULTS
After the treatment with (177)Lu-octreotate, successful surgery was performed in 9 of 29 patients (31%). Six patients had a Whipple procedure, 2 patients had a pylorus-preserving pancreaticoduodenectomy, and 1 patient had a distal pancreatectomy and splenectomy. The median PFS was 69 mo for patients with successful surgery and 49 mo for the other patients. For comparison, the median PFS in 90 other patients with a nonfunctioning pancreatic NET with more than 3 liver metastases or other metastases was 25 mo.


CONCLUSIONS
Neoadjuvant treatment with (177)Lu-octreotate is a valuable option for patients with initially unresectable pancreatic NETs.
Department of Nuclear Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands esthervanvliet@yahoo.com.
Esther I
EI
van Vliet
Department of Surgery, Erasmus Michoacande Ocampo, University Medical Center, Rotterdam, The Netherlands.
Casper H
CH
van Eijck
Department of Pathology, Erasmus Michoacande Ocampo, University Medical Center, Rotterdam, The Netherlands.
Ronald R
RR
de Krijger
Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Elisabeth J
EJ
Nieveen van Dijkum
Department of Nuclear Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
Jaap J
JJ
Teunissen
Department of Nuclear Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
Boen L
BL
Kam
Department of Internal Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands; and.
Wouter W
WW
de Herder
Department of Internal Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands; and.
Richard A
RA
Feelders
Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands.
Bert A
BA
Bonsing
Department of Nuclear Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
Tessa
T
Brabander
Department of Nuclear Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
Eric P
EP
Krenning
Department of Nuclear Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
Dik J
DJ
Kwekkeboom
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000556:secondary; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods*; D060787:Neoplasm Grading; D009362:Neoplasm Metastasis; D015282:Octreotide / Q000031:analogs & derivatives* / Q000627:therapeutic use; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000601:surgery / Q000628:therapy*; D016577:Pancreaticoduodenectomy; D019275:Radiopharmaceuticals / Q000627:therapeutic use*; D013156:Splenectomy; D016019:Survival Analysis; D055815:Young Adult
C554548:177Lu-octreotate; D019275:Radiopharmaceuticals; D015282:Octreotide
PRRT; [177Lu-DOTA0,Tyr3]octreotate; neoadjuvant treatment; pancreatic neuroendocrine tumor; surgery