Pancreatic Surgery Unit, Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute, "Vita-Salute" University, Milan, Italy.
Surgery Department, European Institute of Oncology, Milan, Italy.
Surgery. 2018 Apr;163(4):761-767. doi: 10.1016/j.surg.2017.11.007. Epub 2017 Dec 25.
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.
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.
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).
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.
肽受体放射性核素治疗是胰腺神经内分泌肿瘤的有效治疗选择。本研究的目的是描述肽受体放射性核素治疗作为可切除或潜在可切除胰腺神经内分泌肿瘤新辅助治疗的初步经验。
对 23 例高危复发的可切除或潜在可切除胰腺神经内分泌肿瘤患者（肽受体放射性核素治疗组）进行新辅助肽受体放射性核素治疗后的手术结果与 23 例直接手术患者（直接手术组）进行比较。患者按肿瘤大小、分级和分期匹配。中位随访时间为 61 个月。
新辅助肽受体放射性核素治疗后原发胰腺神经内分泌肿瘤的大小（最大宽度中位数）缩小（59 至 50mm；P=.047）。术中及术后结果无差异，无手术死亡，但与直接手术组相比，肽受体放射性核素治疗组发生胰瘘的风险较低（0/23 比 4/23；P<.02）。肽受体放射性核素治疗组在手术时淋巴结转移的发生率也较低（9/23 比 17/23；P<.02）。两组的疾病特异性中位生存时间均未达到（均无差异，P=.411），无进展中位生存时间也无差异（52 比 37 个月；P>.2），但在 31 例 R0 切除患者中，肽受体放射性核素治疗组的 15 例患者与直接手术组的 16 例患者相比，无进展生存时间似乎更长（无进展中位生存时间未达到 vs 36 个月；P<.05）。
对于高危复发特征的可切除或潜在可切除胰腺神经内分泌肿瘤患者，新辅助肽受体放射性核素治疗似乎是有益的，但需要进行精心设计和更大规模的前瞻性试验，以确认这种方法的安全性和肿瘤学价值。
