Langenbeck's Archives of Surgery

, Volume 395, Issue 2, pp 185–192 | Cite as

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

  • Oliver Stoeltzing
  • Martin Loss
  • Elisabeth Huber
  • Volker Gross
  • Christoph Eilles
  • Jan Mueller-Brand
  • Hans J. Schlitt
Case Management and Clinical Consequences

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.

Keywords

Liver resection Neoadjuvant therapy NET Pancreas Staged surgery 

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Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Oliver Stoeltzing
    • 1
  • Martin Loss
    • 1
  • Elisabeth Huber
    • 2
  • Volker Gross
    • 3
  • Christoph Eilles
    • 4
  • Jan Mueller-Brand
    • 5
  • Hans J. Schlitt
    • 1
  1. 1.Departments of Surgery and Surgical OncologyUniversity of Regensburg Medical CenterRegensburgGermany
  2. 2.Institute of PathologyUniversity of Regensburg Medical CenterRegensburgGermany
  3. 3.Department of Internal Medicine IISt. Marien Hospital AmbergAmbergGermany
  4. 4.Institute of Nuclear MedicineUniversity of Regensburg Medical CenterRegensburgGermany
  5. 5.Institute of Nuclear MedicineUniversity Hospital of BaselBaselSwitzerland

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