Neo-adjuvant systemic radiation therapy for inoperable hepatic hilum neuroendocrine tumor with ¹⁷⁷Lu- DOTATATE:...

The role of neoadjuvant therapy in neuroendocrine tumors (NET) remains an area requiring further advanced clinical exploration. ¹⁷⁷Lu-DOTATATE has demonstrated significant therapeutic efficacy in managing metastatic NET, with reports of notable tumor size reduction in specific cases. This report highlights the case of a young patient diagnosed with an initially inoperable hepatic hilum NET. The patient received two cycles of ¹⁷⁷Lu-DOTATATE, resulting in remarkable tumor shrinkage on follow-up imaging, which facilitated surgical intervention. The patient underwent a complex left trisectionectomy resection, including anastomosis of the right portal vein, resection and interposition graft of the right hepatic artery, Roux-en-Y hepaticojejunostomy, and jejunojejunostomy. Due to residual involvement of the common hepatic duct and right portal vein margins, two additional cycles of adjuvant ¹⁷⁷Lu-DOTATATE were administered post-surgery. Long-term follow-up imaging over a 20-month period has demonstrated stable disease, emphasizing the potential benefits of incorporating neoadjuvant and adjuvant ¹⁷⁷Lu-DOTATATE in selected NET cases.