Peptide receptor radionuclide therapy as a two-step strategy for initially unresectable liver disease from neuroendocrin
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ENDOCRINE SURGERY
Peptide receptor radionuclide therapy as a two-step strategy for initially unresectable liver disease from neuroendocrine tumors: a single-center experience Costanza Chiapponi 1 Nadine Lürssen1 Birgit Cremer2 Roger Wahba1 Uta Drebber3 Michael Faust4 Matthias Schmidt5 Dirk L. Stippel1 ●
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Received: 5 March 2020 / Accepted: 4 May 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose In this study, we describe our experience with peptide receptor radionuclide therapy (PRRT) for initially unresectable liver disease as a two-steps therapeutic strategy, first in neoadjuvant intention before surgery and then later on in case of disease relapse. Methods We performed a retrospective evaluation of four cases of unresectable liver metastases of NET of different origins treated with neoadjuvant Lu-177-DotaTATE for conversion into resectability first and as rechallenging treatment after disease relapse. Results After treatment with Lu-177-DotaTAE, resectability was reached in three of four cases. In one case, SIRT was additionally performed preoperatively. Relapse occurred in three of four cases after 32, 34, and 37 months, respectively, and was managed with Re-PRRT-treatment. Conclusion Although more data are needed, our retrospective study suggests that treatment with Lu-177-DotaTATE is an important adjunct to surgery not only in neoadjuvant intention but also for treating disease relapse. A register study might deliver more evidence for supporting this strategy. Keywords PRRT NEN Hepatic metastases Liver surgery ●
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Introduction
These authors contributed equally: Matthias Schmidt, Dirk L. Stippel * Costanza Chiapponi [email protected] 1
Department for General, Visceral, Cancer and Transplantation Surgery, University Hospital of Cologne, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
2
Department for Hemato-Oncology, University Hospital of Cologne, Univeristy of Cologne, Cologne, Germany
3
Department for Pathology, University Hospital of Cologne, University of Cologne, Cologne, Germany
4
Polyclinic for Endocrinology, Diabetes and Preventive Medicine, University Hospital of Cologne, Univeristy of Cologne, Cologne, Germany
5
Department of Nuclear Medicine, University Hospital of Cologne, University of Cologne, Cologne, Germany
The efficacy of peptide receptor radionuclide therapy (PRRT) with Lu-177 DotaTATE in the treatment of NETs has been increasingly described over the last few decades. Beside one randomized controlled trial (NETTER trial) [1], three meta-analyses [2–4] showed significant disease response and control rates of unresectable metastatic neuroendocrine tumors. Even an improvement of quality of life has been described [5–7]. In a recent network meta-analysis, PRRT is likely to be the most preferable treatment for patients with advanced well-differentiated NETs [8]. Thus, PRRT has become a novel treatment option in NET G3 with a Ki-67 < 50–60% with an overall response
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