Neo-adjuvant systemic radiation therapy for inoperable hepatic hilum neuroendocrine tumor with 177Lu- DOTATATE: successful final surgical resection

TL;DR

A young patient with an inoperable liver tumor was successfully treated with radiation therapy before surgery, allowing for complete tumor removal and long-term stable recovery.

Contribution

Demonstrates the successful use of neoadjuvant and adjuvant 177Lu-DOTATATE therapy to enable surgical resection of an inoperable neuroendocrine tumor.

Findings

Two cycles of 177Lu-DOTATATE reduced tumor size enough to allow complex surgical resection.

Post-surgery adjuvant therapy with 177Lu-DOTATATE helped manage residual disease.

Long-term follow-up showed stable disease over 20 months, highlighting treatment efficacy.

Abstract

The role of neoadjuvant therapy in neuroendocrine tumors (NET) remains an area requiring further advanced clinical exploration. 177Lu-DOTATATE has demonstrated significant therapeutic efficacy in managing metastatic NET, with reports of notable tumor size reduction in specific cases. This report highlights the case of a young patient diagnosed with an initially inoperable hepatic hilum NET. The patient received two cycles of 177Lu-DOTATATE, resulting in remarkable tumor shrinkage on follow-up imaging, which facilitated surgical intervention. The patient underwent a complex left trisectionectomy resection, including anastomosis of the right portal vein, resection and interposition graft of the right hepatic artery, Roux-en-Y hepaticojejunostomy, and jejunojejunostomy. Due to residual involvement of the common hepatic duct and right portal vein margins, two additional cycles of adjuvant 177Lu-DOTATATE were administered post-surgery. Long-term follow-up imaging over a 20-month period has demonstrated stable disease, emphasizing the potential benefits of incorporating neoadjuvant and adjuvant 177Lu-DOTATATE in selected NET cases.

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