Peptide receptor radionuclide therapy as neoadjuvant therapy for resectable or potentially resectable pancreatic neuroendocrine neoplasms

Stefano Partelli, Emilio Bertani, Mirco Bartolomei, Carolina Perali, Francesca Muffatti, Chiara Maria Grana, Marco Schiavo Lena, Claudio Doglioni, Stefano Crippa, Nicola Fazio, Giuseppe Zamboni, Massimo Falconi

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12 Citations (Scopus)

Abstract

Background: Peptide receptor radionuclide therapy is a valid therapeutic option for pancreatic neuroendocrine neoplasms. The aim of this study was to describe an initial experience with the use of peptide receptor radionuclide therapy as a neoadjuvant agent for resectable or potentially resectable pancreatic neuroendocrine neoplasms. Methods: The postoperative outcomes of 23 patients with resectable or potentially resectable pancreatic neuroendocrine neoplasms at high risk of recurrence who underwent neoadjuvant peptide receptor radionuclide therapy (peptide receptor radionuclide therapy group) were compared with 23 patients who underwent upfront surgical operation (upfront surgery group). Patients were matched for tumor size, grade, and stage. Median follow-up was 61 months. Results: The size (median greatest width) of the primary pancreatic neuroendocrine neoplasms decreased after neoadjuvant peptide receptor radionuclide therapy (59 to 50 mm; P =.047). There were no differences in intraoperative and postoperative outcomes and there were no operative deaths, but the risk of developing a pancreatic fistula tended to be less in the peptide receptor radionuclide therapy group when compared to the upfront surgery group (0/23 vs 4/23; P <.02). The incidence of nodal metastases at the time of resection was also less in the peptide receptor radionuclide therapy group (n = 9/23 vs 17/23; P <.02). Neither median disease-specific survival (not reached in either group; P =.411) nor progression-free survival (52 vs 37 months; P >.2) differed between groups, but progression-free survival in the 31 patients who had an R0 resection seemed to be greater in the 15 patients in the peptide receptor radionuclide therapy group versus 16 patients the upfront group (median progression-free survival not reached vs 36 months; P <.05). Conclusion: Neoadjuvant peptide receptor radionuclide therapy for resectable or potentially resectable pancreatic neuroendocrine neoplasms in patients with high-risk features of recurrence seems to be beneficial, but well-designed and much larger prospective trials are needed to confirm the safety and the oncologic value of this approach.

Original languageEnglish
Pages (from-to)761-767
Number of pages7
JournalSurgery (United States)
Volume163
Issue number4
DOIs
Publication statusPublished - Apr 1 2018

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Neoadjuvant Therapy
Peptide Receptors
Pancreatic Neoplasms
Radioisotopes
Group Psychotherapy
Therapeutics
Disease-Free Survival
Pancreatic Fistula
Recurrence
Safety

ASJC Scopus subject areas

  • Surgery

Cite this

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title = "Peptide receptor radionuclide therapy as neoadjuvant therapy for resectable or potentially resectable pancreatic neuroendocrine neoplasms",
abstract = "Background: Peptide receptor radionuclide therapy is a valid therapeutic option for pancreatic neuroendocrine neoplasms. The aim of this study was to describe an initial experience with the use of peptide receptor radionuclide therapy as a neoadjuvant agent for resectable or potentially resectable pancreatic neuroendocrine neoplasms. Methods: The postoperative outcomes of 23 patients with resectable or potentially resectable pancreatic neuroendocrine neoplasms at high risk of recurrence who underwent neoadjuvant peptide receptor radionuclide therapy (peptide receptor radionuclide therapy group) were compared with 23 patients who underwent upfront surgical operation (upfront surgery group). Patients were matched for tumor size, grade, and stage. Median follow-up was 61 months. Results: The size (median greatest width) of the primary pancreatic neuroendocrine neoplasms decreased after neoadjuvant peptide receptor radionuclide therapy (59 to 50 mm; P =.047). There were no differences in intraoperative and postoperative outcomes and there were no operative deaths, but the risk of developing a pancreatic fistula tended to be less in the peptide receptor radionuclide therapy group when compared to the upfront surgery group (0/23 vs 4/23; P <.02). The incidence of nodal metastases at the time of resection was also less in the peptide receptor radionuclide therapy group (n = 9/23 vs 17/23; P <.02). Neither median disease-specific survival (not reached in either group; P =.411) nor progression-free survival (52 vs 37 months; P >.2) differed between groups, but progression-free survival in the 31 patients who had an R0 resection seemed to be greater in the 15 patients in the peptide receptor radionuclide therapy group versus 16 patients the upfront group (median progression-free survival not reached vs 36 months; P <.05). Conclusion: Neoadjuvant peptide receptor radionuclide therapy for resectable or potentially resectable pancreatic neuroendocrine neoplasms in patients with high-risk features of recurrence seems to be beneficial, but well-designed and much larger prospective trials are needed to confirm the safety and the oncologic value of this approach.",
author = "Stefano Partelli and Emilio Bertani and Mirco Bartolomei and Carolina Perali and Francesca Muffatti and Grana, {Chiara Maria} and {Schiavo Lena}, Marco and Claudio Doglioni and Stefano Crippa and Nicola Fazio and Giuseppe Zamboni and Massimo Falconi",
year = "2018",
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doi = "10.1016/j.surg.2017.11.007",
language = "English",
volume = "163",
pages = "761--767",
journal = "Surgery",
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T1 - Peptide receptor radionuclide therapy as neoadjuvant therapy for resectable or potentially resectable pancreatic neuroendocrine neoplasms

AU - Partelli, Stefano

AU - Bertani, Emilio

AU - Bartolomei, Mirco

AU - Perali, Carolina

AU - Muffatti, Francesca

AU - Grana, Chiara Maria

AU - Schiavo Lena, Marco

AU - Doglioni, Claudio

AU - Crippa, Stefano

AU - Fazio, Nicola

AU - Zamboni, Giuseppe

AU - Falconi, Massimo

PY - 2018/4/1

Y1 - 2018/4/1

N2 - Background: Peptide receptor radionuclide therapy is a valid therapeutic option for pancreatic neuroendocrine neoplasms. The aim of this study was to describe an initial experience with the use of peptide receptor radionuclide therapy as a neoadjuvant agent for resectable or potentially resectable pancreatic neuroendocrine neoplasms. Methods: The postoperative outcomes of 23 patients with resectable or potentially resectable pancreatic neuroendocrine neoplasms at high risk of recurrence who underwent neoadjuvant peptide receptor radionuclide therapy (peptide receptor radionuclide therapy group) were compared with 23 patients who underwent upfront surgical operation (upfront surgery group). Patients were matched for tumor size, grade, and stage. Median follow-up was 61 months. Results: The size (median greatest width) of the primary pancreatic neuroendocrine neoplasms decreased after neoadjuvant peptide receptor radionuclide therapy (59 to 50 mm; P =.047). There were no differences in intraoperative and postoperative outcomes and there were no operative deaths, but the risk of developing a pancreatic fistula tended to be less in the peptide receptor radionuclide therapy group when compared to the upfront surgery group (0/23 vs 4/23; P <.02). The incidence of nodal metastases at the time of resection was also less in the peptide receptor radionuclide therapy group (n = 9/23 vs 17/23; P <.02). Neither median disease-specific survival (not reached in either group; P =.411) nor progression-free survival (52 vs 37 months; P >.2) differed between groups, but progression-free survival in the 31 patients who had an R0 resection seemed to be greater in the 15 patients in the peptide receptor radionuclide therapy group versus 16 patients the upfront group (median progression-free survival not reached vs 36 months; P <.05). Conclusion: Neoadjuvant peptide receptor radionuclide therapy for resectable or potentially resectable pancreatic neuroendocrine neoplasms in patients with high-risk features of recurrence seems to be beneficial, but well-designed and much larger prospective trials are needed to confirm the safety and the oncologic value of this approach.

AB - Background: Peptide receptor radionuclide therapy is a valid therapeutic option for pancreatic neuroendocrine neoplasms. The aim of this study was to describe an initial experience with the use of peptide receptor radionuclide therapy as a neoadjuvant agent for resectable or potentially resectable pancreatic neuroendocrine neoplasms. Methods: The postoperative outcomes of 23 patients with resectable or potentially resectable pancreatic neuroendocrine neoplasms at high risk of recurrence who underwent neoadjuvant peptide receptor radionuclide therapy (peptide receptor radionuclide therapy group) were compared with 23 patients who underwent upfront surgical operation (upfront surgery group). Patients were matched for tumor size, grade, and stage. Median follow-up was 61 months. Results: The size (median greatest width) of the primary pancreatic neuroendocrine neoplasms decreased after neoadjuvant peptide receptor radionuclide therapy (59 to 50 mm; P =.047). There were no differences in intraoperative and postoperative outcomes and there were no operative deaths, but the risk of developing a pancreatic fistula tended to be less in the peptide receptor radionuclide therapy group when compared to the upfront surgery group (0/23 vs 4/23; P <.02). The incidence of nodal metastases at the time of resection was also less in the peptide receptor radionuclide therapy group (n = 9/23 vs 17/23; P <.02). Neither median disease-specific survival (not reached in either group; P =.411) nor progression-free survival (52 vs 37 months; P >.2) differed between groups, but progression-free survival in the 31 patients who had an R0 resection seemed to be greater in the 15 patients in the peptide receptor radionuclide therapy group versus 16 patients the upfront group (median progression-free survival not reached vs 36 months; P <.05). Conclusion: Neoadjuvant peptide receptor radionuclide therapy for resectable or potentially resectable pancreatic neuroendocrine neoplasms in patients with high-risk features of recurrence seems to be beneficial, but well-designed and much larger prospective trials are needed to confirm the safety and the oncologic value of this approach.

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