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Introduction: Liver transplantation is an important option for patients of neuroendocrine tumors (NET) with metastases limited to the liver. Peptide receptor radionuclide therapy (PRRNT) is effective in the management of metastatic NET. Aim(s): To assess safety and efficacy of PRRNT after liver transplantation in metastatic NET. Materials and methods: This was a retrospective analysis in five patients (age 52±9 years; four males and one female) of NET with progressive extra hepatic metastatic disease after liver transplantation. None of the patients had evidence of recurrent disease in the transplanted liver. The patients received PRRNT with 3, 2, 2, 1 and 2 cycles respectively with Lu-177 alone, the cumulative administered activity ranging from 7.6 to 22.3 GBq after liver transplantation. Results: Three out of the five patients had grade 1 erythrocytopenia and two of the patients showed evidence of grade 1 renal toxicity. Two of the patients had stable disease, while in two patients it continued to progress. The follow-up is awaited in one patient. Conclusion: PRRNT is a safe and effective therapeutic option for progressive disease after liver transplantation in NET. [ABSTRACT FROM AUTHOR]

Introduction: Hepatic metastases significantly affect the overall prognosis and quality of life in patients with gastroenteropancreatic neuroendocrine tumours (GEP-NET). Radiofrequency ablation (RFA) is one of the important local ablative strategies for hepatic metastases. Peptide receptor radionuclide therapy (PRRNT) is a well-established therapeutic modality for metastatic NET. Aim(s): To assess the efficacy of combined PRRNT and RFA in the management of hepatic metastases of NET. Materials and methods: Nine patients of known metastatic GEP-NET underwent PRRNT (2-5 cycles with Lu-177 and/or Y-90 labeled DOTATATE/DOTATOC) before or after RFA for hepatic metastases. All patients had undergone SSTR PET/CT using Ga-68 DOTATOC before and after the therapies and also for follow-up. Results: In four out of the 10 patients, there was a complete remission over a follow-up period of respectively 36 months, 16 months, nine months and six months, one patient had partial remission over 18 months and one patient stable disease over 30 month follow-up period to date. However in three patients, the disease continued to progress. On retrospective analysis, two out of these patients had intermediate grade NET and one had high grade NET. Conclusion: PRRNT in combination with RFA is effective in the management of hepatic metastases in GEP-NET. [ABSTRACT FROM AUTHOR]

Introduction: Patients with gastroenteropancreatic neuroendocrine tumors (GEP-NET) present frequently with hepatic metastases. Radiofrequency ablation (RFA) is an important local ablative treatment for hepatic metastases. Aim(s): To evaluate the role of Ga-68 somatostatin receptor PET/CT (SSTR PET/CT) in the assessment of response to RFA in hepatic metastases of NET in comparison with the other radiological imaging modalities. Materials and methods: Ten patients of known GEP-NET underwent RFA (in total of 17 segments) for hepatic metastases. All patients had undergone SSTR PET/CT using Ga-68 DOTATOC, 4-phase CT, MRI and USG before, and 3-6 months after RFA. Results: In six out of the 10 patients in 13 liver segments, there was a complete necrosis in the metastases as noted by cold lesions on post-therapy 4-phase CT, MRI and USG, and no uptake on SSTR PET/CT. In the remaining four patients, there was a minor molecular response in the metastases on SSTR PET/CT (>25% decrease in standardized uptake values on post-therapy PET). In two of these four patients, there were no significant detectable changes on USG. In one patient, CT and MRI could not detect any changes to indicate response to RFA. Conclusion: SSTR PET/CT may be better than morphological imaging modalities for restaging of hepatic metastases of GEP-NET after RFA, as it assesses the viability and functional response by accurate quantification of somatostatin receptor expression in the metastases. [ABSTRACT FROM AUTHOR]