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J Nucl Med. 2015 Nov;56(11):1647-53. doi: 10.2967/jnumed.115.158899. Epub 2015 Aug 13.

Neoadjuvant Treatment of Nonfunctioning Pancreatic Neuroendocrine Tumors with [177Lu-DOTA0,Tyr3]Octreotate.

Author information

1
Department of Nuclear Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands esthervanvliet@yahoo.com.
2
Department of Surgery, Erasmus Michoacande Ocampo, University Medical Center, Rotterdam, The Netherlands.
3
Department of Pathology, Erasmus Michoacande Ocampo, University Medical Center, Rotterdam, The Netherlands.
4
Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
5
Department of Nuclear Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
6
Department of Internal Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands; and.
7
Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands.

Abstract

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.

KEYWORDS:

PRRT; [177Lu-DOTA0,Tyr3]octreotate; neoadjuvant treatment; pancreatic neuroendocrine tumor; surgery

PMID:
26272813
DOI:
10.2967/jnumed.115.158899
[Indexed for MEDLINE]
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