Successful neoadjuvant peptide receptor radionuclide therapy for an inoperable pancreatic neuroendocrine tumour

Non-functional pancreatic neuroendocrine tumours (NETs) can present with advanced local or distant (metastatic) disease limiting the possibility of surgical cure. Several treatment options have been used in experimental neoadjuvant settings to improve the outcomes in such cases. Peptide receptor radionuclide therapy (PPRT) using beta emitting radiolabelled somatostatin analogues has been used in progressive pancreatic NETs. We report a 55-year-old female patient with a 12.8 cm pancreatic NET with significant local stomach and superior mesenteric vein compression and liver metastases. The patient underwent treatment with [(177)Lutetium-DOTA(0,)Tyr(3)]octreotate ((177)Lu-octreotate) for the treatment of local and metastatic symptomatic disease. Six months after 4 cycles of (177)lutetium-octreotate, resolution of the abdominal complaints was associated with a significant reduction in tumour size and the tumour was rendered operable. Histology of the tumour showed a 90% necrotic tumour with abundant hyalinized fibrosis and haemorrhage compatible with PPRT-induced radiation effects on tumour cells. This report supports that PPRT has a role in unresectable and metastatic pancreatic NET. LEARNING POINTS: PRRT with (177)Lu-octreotate can be considered a useful therapy for symptomatic somatostatin receptor-positive pancreatic NET. The clinical benefits of PRRT with (177)Lu-octreotate can be seen in the first months while tumour reduction can be seen up to a year after treatment. PRRT with (177)Lu-octreotate was clinically well tolerated and did not interfere with the subsequent surgical procedure. PRRT with (177)Lu-octreotate can result in significant tumour reduction and may improve surgical outcomes. As such, this therapy can be considered as a neoadjuvant therapy.