Neoadjuvant peptide receptor radionuclide therapy for aninoperable neuroendocrine pancreatic tumor

Kaemmerer, Daniel; Prasad, Vinay; Daffner, Wolfgang; Hörsch, Dieter; Klöppel, Günter; Hommann, Merten; Baum, R. P.

doi:10.3748/wjg.15.5867

Cited by 78 publications

(55 citation statements)

References 18 publications

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“…Three patients received 90 Y-based somatostatin analogs (10)(11)(12), and 2 patients 177 Lu-based somatostatin analogs (13,14). Although these case reports demonstrate the potential of PRRT in a neoadjuvant setting, follow-up after surgery was limited.…”

Section: Discussionmentioning

confidence: 99%

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

Vliet

Eijck²,

Krijger³

et al. 2015

J Nucl Med

103

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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 Luoctreotate) 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 Luoctreotate, 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.

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Section: Discussionmentioning

confidence: 99%

“…A few case reports have described the use of PRRT as neoadjuvant treatment in patients with pancreatic NETs (10)(11)(12)(13)(14). Here, we describe our experience with [ 177 Lu-DOTA 0 ,Tyr 3 ]octreotate ( 177 Lu-octreotate) treatment of a large series of patients with nonfunctioning pancreatic NETs in a neoadjuvant setting with a long follow-up.…”

mentioning

confidence: 99%

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

Vliet

Eijck²,

Krijger³

et al. 2015

J Nucl Med

103

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“…Surgical treatment remains the primary approach in primary gastroenteropancreatic neurendocrine tumours, including pancreatic tumours. Surgery is the golden standard in the treatment of pancreatic neuroendocrine tumours, both as radical tumour excision and as palliative treatment aimed at alleviating the clinical complaints and improving the quality of life (1,5,(8)(9)(10)(11)(12)(13)(14)(15)(16).…”

Section: Discussionmentioning

confidence: 99%

“…Laparoscopic access is contraindicated for tumours exceeding 10 cm in diameter, with metastases and infiltration of major blood vessels. For malignant tumours and in cases of their more pronounced clinical advancement, the scope of the procedure should be adequately larger (1,5,7,8,11,(13)(14)(15)(16)(17)(18).…”

Section: Discussionmentioning

confidence: 99%

Surgical Treatment of Pancreatic Neuroendocrine Tumours - Clinical Experience

Jabłońska

Dranka-Bojarowska²,

Palacz³

et al. 2011

Polish Journal of Surgery

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the aim of the work was the clinical characteristics and analysis of preliminary results for surgical treatment of pancreatic neuroendocrine tumors (PNETs), based on own material. material and methods. In the period from 2005 to 2009, in the Department of Gastrointestinal Surgery, Silesian Medical University in Katowice, there were 27 patients (15 males and 12 females) treated surgically for pancreatic neuroendocrine tumours, constituting 65.86% (27/41) of all gastroenteropancreatic neuroendocrine tumours. Prior to the surgery, the following diagnostic examinations were performed: laboratory tests and imaging examinations (abdominal ultrasound and CT scan). The following tumour localisation was established: head of the pancreas -14, body of the pancreas -4, tail of the pancreas -5, body and tail of the pancreas -1, retroperitoneal space -4. There were found 24 (88.89%) primary tumours and 3 (11.11%) recurrences. The following methods of surgical treatment were applied: pancreatoduodenectomy -11, distal pancreatic resection with splenectomy -6, middle segment resection with anastomosis between the pancreatic tail and jejunal loop: Roux-Y procedure -1, pancreatic resection by Beger procedure -1, pancreatic head and body resection with splenectomy -1, tumour enucleation or local excision -4, exploratory laparotomy with specimen collection -3. Results. The mean hospitalisation period was 25 days (4 -78 days). The mean procedure duration was 4.2 hours (1.15-9.15 hours). Early post-operative complications were observed in 10 patients (37.04%). The following early complications were observed: intra-abdominal abscess -2, wound suppuration -2, pancreatic fistula -1, acute pancreatitis -1, pancreaticojejunal anastomosis leak -1, peritoneal cavity haemorrhage -1, acute cholangitis -1, adhesion obstruction -1, subobstruction -1, portal vein thrombosis -1, sepsis -1, fluid in pleural cavity -1, acute heart failure -1. There were performed 2 (7.41%) repeat surgeries: one due to adhesion obstruction and one due to peritoneal cavity haemorrhage. Death of 1 patient (3.71%) was recorded in the post-operative period due to acute heart failure. conclusions. Pancreatic neuroendocrine tumours constituted the majority of gastroenteropancreatic neuroendocrine tumours in the analysed patient group. Most commonly, PNETs were localised in the head of the pancreas. In the presented material, the mortality rate does not exceed 4%, similarly as in other renowned centres.

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“…A few case reports have described the neoadjuvant use of PRRT in patients with pancreatic NETs who could be operated on successfully after PRRT (33,34). As surgery is the only curative option for patients with GEPNETs, this neoadjuvant treatment is very promising.…”

Section: Prrt: Variantsmentioning

confidence: 99%

GEP–NETs UPDATE: Radionuclide therapy in neuroendocrine tumors

Zwan

Bodei

Müeller-Brand

et al. 2015

European Journal of Endocrinology

112

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Peptide receptor radionuclide therapy (PRRT) is a promising new treatment modality for inoperable or metastasized gastroenteropancreatic neuroendocrine tumors (GEPNETs) patients. Most studies report objective response rates in 15-35% of patients. Also, outcome in terms of progression free survival (PFS) and overall survival compares very favorably with that for somatostatin analogs, chemotherapy, or new, 'targeted' therapies. They also compare favorably to PFS data for liverdirected therapies. Two decades after the introduction of PRRT, there is a growing need for randomized controlled trials comparing PRRT to 'standard' treatment, that is treatment with agents that have proven benefit when tested in randomized trials. Combining PRRT with liver-directed therapies or with targeted therapies could improve treatment results. The question to be answered, however, is whether a combination of therapies performed within a limited time-span from one another results in a better PFS than a strategy in which other therapies are reserved until after (renewed) tumor progression. Randomized clinical trials comparing PRRT with other treatment modalities should be undertaken to determine the best treatment options and treatment sequelae for patients with GEPNETs. European Journal of Endocrinology (2015) 172, R1-R8Invited Authors' profiles: Dik Kwekkeboom, MD works for the Department of Nuclear Medicine at the University Hospital, Erasmus MC, Rotterdam, The Netherlands. His major research interest is peptide receptor imaging and he coordinates the studies on therapy with the radiolabelled somatin analog 177 Lu-octreotate in patients with neuroendocrine tumors. He has numerous publications in international journals and textbooks, mainly in the field of endocrinology and peptide receptor scintigraphy and therapy.Wouter A van der Zwan currently works as research physician within the peptide receptor radionuclide therapy (PRRT) team at the Department of Nuclear Medicine of the Erasmus MC, Rotterdam and is directly involved in the treatment of patients affected by a Neuroendocrine Tumor with PRRT. Besides the clinical care of patients undergoing PRRT, his work includes conducting scientific research on the early and late effects, and optimization of PRRT. European Journal of EndocrinologyReview W A van der Zwan and others PRRT in neuroendocrine tumors 172:1 R1-R8

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Neoadjuvant peptide receptor radionuclide therapy for aninoperable neuroendocrine pancreatic tumor

Cited by 78 publications

References 18 publications

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

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

Surgical Treatment of Pancreatic Neuroendocrine Tumours - Clinical Experience

GEP–NETs UPDATE: Radionuclide therapy in neuroendocrine tumors

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Neoadjuvant peptide receptor radionuclide therapy for aninoperable neuroendocrine pancreatic tumor

Cited by 78 publications

References 18 publications

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

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

Surgical Treatment of Pancreatic Neuroendocrine Tumours - Clinical Experience

GEP–NETs UPDATE: Radionuclide therapy in neuroendocrine tumors

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Product

Resources

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

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