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Published on: April 17, 2019
Neoadjuvant Treatment of Nonfunctioning Pancreatic Neuroendocrine Tumors with [177Lu-DOTA0,Tyr3]Octreotate
Esther I van Vliet1, Casper H van Eijck2, Ronald R de Krijger3
1Department of Nuclear Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands esthervanvliet@yahoo.com.
Unlabelled:
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.
Conclusion:
Neoadjuvant treatment with (177)Lu-octreotate is a valuable option for patients with initially unresectable pancreatic NETs.
Insights
Neoadjuvant treatment with lutetium (177Lu)oxodotreotide ((177)Lu-octreotate) can make initially unresectable pancreatic neuroendocrine tumors (NETs) operable. This approach offers a valuable option for patients with advanced NETs, improving outcomes.
Area of Science:
- Oncology
- Nuclear Medicine
- Gastroenterology
Background:
- Pancreatic neuroendocrine tumors (NETs) are rare and surgery offers the only cure.
- Unresectable tumors due to size or vascular involvement limit surgical options.
Purpose of the Study:
- To evaluate the efficacy of neoadjuvant (177)Lu-octreotate in patients with initially unresectable pancreatic NETs.
- To assess the impact of this treatment on surgical outcomes and progression-free survival.
Main Methods:
- A study of 29 Dutch patients with nonfunctioning pancreatic NETs treated with (177)Lu-octreotate.
- Patients had borderline/unresectable tumors or limited liver metastases (oligometastatic disease).
- Progression-free survival (PFS) analyzed using Kaplan-Meier and Cox modeling.
Main Results:
- Surgery was successful in 31% (9/29) of patients after (177)Lu-octreotate treatment.
- Median PFS was 69 months for patients who underwent successful surgery versus 49 months for others.
- This contrasts with a median PFS of 25 months in patients with more extensive metastases.
Conclusions:
- Neoadjuvant (177)Lu-octreotate is a viable strategy for initially unresectable pancreatic NETs.
- This treatment can facilitate surgical resection, improving patient outcomes.
- (177)Lu-octreotate offers a promising therapeutic option for advanced pancreatic NETs.
