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Resection of the Primary Tumor Followed by Peptide Receptor Radionuclide Therapy as Upfront Strategy for the Treatment of G1–G2 Pancreatic Neuroendocrine Tumors with Unresectable Liver Metastases

Annals of Surgical Oncology volume 23, pages 981–989 (2016)Cite this article

Abstract

Background

A low burden of disease represents an independent favorable prognostic factor of response to peptide receptor radionuclide therapy (PRRT) in patients affected by gastro-entero-pancreatic neuroendocrine tumors. However, it is not clear whether this is due to a lower diffusion of the disease or thanks to debulking surgery.

Methods

From 1996 to 2013 those patients diagnosed with G1–G2 pancreatic neuroendocrine tumor (PNET) and synchronous liver metastases who were not deemed eligible for liver radical surgery but were eligible to receive upfront PRRT were prospectively included in the study. Two groups of comparison were identified: those submitted for primary tumor resection before PRRT and those who were not. The outcome was evaluated as: objective response to PRRT (OR), progression-free survival (PFS), and overall survival (OS).

Results

Of the 94 subjects, 31 were previously submitted for primary tumor resection. After propensity score adjustments, patients who underwent surgery before PRRT showed higher stabilization or objective responses after PRRT (p = .006), and this translated into a better median PFS (70 vs. 30 months; p = .002) and OS (112 vs. 65 months; p = .011), for operated versus nonoperated patients, respectively. At multivariate analysis, operated patients showed a statistically significantly improved PFS: HR, 5.11 (95 % CI 1.43–18.3); p = .012, whereas Ki-67 in continuous fashion was correlated significantly with OS: 1.13 (95 % CI 1–1.27); p = .048.

Conclusions

Primary tumor resection prior to PRRT can be safely proposed in G1–G2 PNETs with diffuse liver metastases because it seems to enhance response to PRRT and to improve significantly PFS.

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Acknowledgment

We thank William Russell-Edu for his assistance in reviewing the English of this text. This work was supported by the Italian Association for Neuroendocrine Tumors (It.A.Net).

Disclosure

The authors declare that they have no conflict of interest.

Author information

Affiliations

  1. Division of Hepatobilio-pancreatic Surgery, European Institute of Oncology, Milan, Italy

    Emilio Bertani MD

  2. GI and Neuroendocrine Tumors Unit, European Institute of Oncology, Milan, Italy

    Nicola Fazio MD & Francesca Spada MD

  3. Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy

    Davide Radice MSc

  4. Surgical Department, Sacro Cuore Hospital, Negrar, Italy

    Claudio Zardini MD

  5. Division of Nuclear Medicine, European Institute of Oncology, Milan, Italy

    Chiara Grana MD & Lisa Bodei MD

  6. Molecular Imaging and Therapy Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, USA

    Lisa Bodei MD

  7. Division of Radiology, European Institute of Oncology, Milan, Italy

    Luigi Funicelli MD

  8. Division of Digestive Surgery, European Institute of Oncology, Milan, Italy

    Carlo Ferrari MD

  9. Division of Pancreatic Surgery, Ospedale San Raffaele IRCCS, Università Vita e Salute, Milan, Italy

    Stefano Partelli MD, PhD & Massimo Falconi MD

Authors
  1. Emilio Bertani MD
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  2. Nicola Fazio MD
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  3. Davide Radice MSc
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  4. Claudio Zardini MD
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  5. Chiara Grana MD
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  6. Lisa Bodei MD
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  7. Luigi Funicelli MD
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  8. Carlo Ferrari MD
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  9. Francesca Spada MD
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  10. Stefano Partelli MD, PhD
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  11. Massimo Falconi MD
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Corresponding author

Correspondence to Emilio Bertani MD.

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Bertani, E., Fazio, N., Radice, D. et al. Resection of the Primary Tumor Followed by Peptide Receptor Radionuclide Therapy as Upfront Strategy for the Treatment of G1–G2 Pancreatic Neuroendocrine Tumors with Unresectable Liver Metastases. Ann Surg Oncol 23, 981–989 (2016). https://doi.org/10.1245/s10434-016-5550-3

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  • DOI: https://doi.org/10.1245/s10434-016-5550-3

Keywords

  • Overall Survival
  • Liver Metastasis
  • Propensity Score
  • Neuroendocrine Tumor
  • National Comprehensive Cancer Network