ECE2020 Audio ePoster Presentations Pituitary and Neuroendocrinology (217 abstracts)
Surgical and survival outcomes of early peptide receptor radionuclide therapy for downstaging locally advanced or oligometastatic pancreatic neuroendocrine neoplasms
Noémie Minczeles 1,2 , CHJ van Eijck 3 , MJ van Gils 2 , MF van Velthuysen 4 , EJM Nieveen van Dijkum 5 , Richard Feelders 1 , Wouter W de Herder 1 , T Brabander 2* & Hans Hofland 1*
1Erasmus University Medical Center, Department of Internal Medicine, Section of Endocrinology, Rotterdam, Netherlands; 2Erasmus University Medical Center, Department of Radiology & Nuclear Medicine, Rotterdam, Netherlands; 3Erasmus University Medical Center, Department of Surgery, Rotterdam, Netherlands; 4Erasmus University Medical Center, Department of Pathology, Rotterdam, Netherlands; 5Amsterdam University Medical Centers, Department of Surgery, Amsterdam, Netherlands
Introduction: Pancreatic neuroendocrine neoplasm (pNEN) patients often present with locally advanced or metastatic disease. The objective response rate of peptide receptor radionuclide therapy (PRRT) in pNENs is 55%. Therefore, PRRT may be a possibility for patients who are not eligible for upfront curative surgery.
Aims: To assess the potency of PRRT to render locally advanced or oligometastatic pNENs resectable and to evaluate the effect of surgery after early PRRT on survival.
Material and Methods: A single-center retrospective analysis was performed on 50 pNEN patients, treated between 2000 and 2019 with 177Lu-DOTATATE with a neoadjuvant or downstaging intent. Patients had resectable, borderline resectable or unresectable locoregional disease and/or metastatic disease.
Results: After PRRT, 26 patients underwent surgery with curative intent. Surgical and non-surgical patients had equal tumor diameters and metastatic sites at baseline. Patients in the surgical group had more grade 1 tumors than those in the non-surgical group (P = 0.001) and more often completed the intended PRRT dose of 29.6 GBq (P = 0.007). In 54% and 46% of the surgical and in 21% and 63% of the non-surgical patients, best responses were partial response and stable disease, respectively (P = 0.02). One patient died due to surgical complications. Median progression free survival was 28 months for the non-surgical group and 68 months for the surgical group (P = 0.009). Median overall survival was 66 months for the non-surgical group compared to 177 months for the surgical group (P = 0.002).
Conclusions: This study shows the favorable long-term outcomes of pNEN patients that underwent surgery after neoadjuvant PRRT. Early PRRT followed by surgical evaluation is an option for patients with unresectable or oligometastatic pNEN.
Keywords: neoadjuvant, peptide receptor radionuclide therapy, neuroendocrine, pancreas, surgery.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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