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Staged surgery with neoadjuvant 90Y-DOTATOC therapy for down-sizing synchronous bilobular hepatic metastases from a neuroendocrine pancreatic tumor

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Abstract

Purpose

Treatment with DOTA-d-Phe(1)-Tyr(3)-octreotide (DOTATOC), labeled with beta-emitting radioisotope yttrium-90 (90Y-DOTATOC), has successfully been used for the palliative treatment of patients with advanced somatostatin receptor-expressing neuroendocrine tumors (NETs). However, controversy persists as to whether patients with metastatic NETs of the pancreas should undergo radical (salvage) surgery or receive palliative therapy. We proposed that 90Y-DOTATOC could be used in a neoadjuvant intention for improving therapy of hepatic NET metastases.

Materials and methods

We investigated a novel therapy concept in a 49-year-old patient presenting with a neuroendocrine tumor of the pancreatic tail and synchronous multiple bilobular hepatic metastases. After surgical removal of the large primary tumor by extended left en bloc resection of the pancreatic tail, the patient received neoadjuvant 90Y-DOTATOC for therapy of primarily non-resectable bilobular hepatic metastases.

Results

The 90Y-DOTATOC therapy resulted in an impressive regression of hepatic lesions, thus facilitating surgical removal of all remaining liver metastases in a second operation (staged surgery). In addition, one lesion was ablated using radiofrequency ablation (RFA). At 1-year of follow-up after hepatic R0 resection/RFA, there was no evidence of tumor recurrence or extrahepatic metastasis.

Conclusions

The neoadjuvant use of 90Y-DOTATOC therapy could prove valuable for treatment of advanced pancreatic NETs metastatic to the liver in terms of facilitating R0 resection by applying staged surgery concepts.

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Authors and Affiliations

  1. Departments of Surgery and Surgical Oncology, University of Regensburg Medical Center, Franz-Josef-Strauss-Allee 11, 93042, Regensburg, Germany

    Oliver Stoeltzing, Martin Loss & Hans J. Schlitt

  2. Institute of Pathology, University of Regensburg Medical Center, Regensburg, Germany

    Elisabeth Huber

  3. Department of Internal Medicine II, St. Marien Hospital Amberg, Amberg, Germany

    Volker Gross

  4. Institute of Nuclear Medicine, University of Regensburg Medical Center, Regensburg, Germany

    Christoph Eilles

  5. Institute of Nuclear Medicine, University Hospital of Basel, Basel, Switzerland

    Jan Mueller-Brand

Authors
  1. Oliver Stoeltzing
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  2. Martin Loss
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  3. Elisabeth Huber
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  4. Volker Gross
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  5. Christoph Eilles
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  6. Jan Mueller-Brand
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  7. Hans J. Schlitt
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Correspondence to Oliver Stoeltzing.

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Stoeltzing, O., Loss, M., Huber, E. et al. Staged surgery with neoadjuvant 90Y-DOTATOC therapy for down-sizing synchronous bilobular hepatic metastases from a neuroendocrine pancreatic tumor. Langenbecks Arch Surg 395, 185–192 (2010). https://doi.org/10.1007/s00423-009-0520-x

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  • DOI: https://doi.org/10.1007/s00423-009-0520-x

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