Hepatic transplant and use of radionuclides as adyuvant therapies for patients with metastasic disease from neuroendocrine tumors
Maria Isabel Del Olmo1, Maria Argente1, Agustin Ramos1, Rosa Camara1, Maria Soledad Navas1, Vicente Campos1, Angel Moya2 & Juan Francisco Merino-Torres1
Aim: Patients with malignant neuroendocrine tumors (mNETs) present frequently metastatic disease at diagnosis or during their follow-up. Hepatic transplant (HT) and radionuclide treatment have proved to be successful treatments. The aim of this report is to study the progression of the disease in patients with metastasic mNETs and HT.
Patients and methods: Descriptive and retrospective study of patients diagnosed of metastasic mNETs and submitted to HT during the period 19842009 in our hospital. Data regarding demographic, clinical, analytical, anatomopathological and diagnostic variables were collected. Results are expressed as mean±S.D.
Results: Twelve patients (67% men) with 44.1±9.2 years at diagnosis and a BMI of 25.2±3.3 kg/m2 were studied. Tumors were classified as carcinoid (50%), pancreatic neuroendocrine carcinoma (25%), insulinoma (8.3%), glucagonoma (8.3%) and somatostatinoma (8.3%). Half of the patients presented typical clinical syndrome of their mNETs. Of 83% had hepatic metastases at diagnosis and the rest (17%) developed them 29 months later. HT was performed 14.3±7.7 months after the diagnosis of metastases. The complications due to transplant procedure and inmunosupression described were: rejection (33.3%), hepatic arterial thrombosis (8.3%) that required retransplantation and infectious disease (8.3%). Four patients were submitted for radionuclide therapy with 177Lu-DOTATATE and 90Y-DOTATATE to a reference hospital. The total dose administered was of 408.5±171.5 mCi with mean sessions of 4.3±1.7. The response to radionuclide was satisfactory: 2 stable, 1 reduction and 1 progression. In the present moment there is a 100% of survival and 25% present progression after a mean follow-up of 89.9±81.2 months.
Conclusions: HT is an effective therapeutic option in patients with mNETs and metastasic disease, presenting a low morbility and adequate survival in long term follow-up. Radionuclide therapy is useful in some of these patients, stabilizing the disease in 75% of them.