Background : PRRT has emerged as treatment choice for inoperable or metastasized neuroendocrine tumors and this therapy seems more effective in the biochemical and volume control of disease than SSA or chemotherapy alone. Majority of the patients will have hepatic metastases at the time of presentation itself.
Aim: To demonstrate the efficacy and safety of Liver directed PRRT along with concurrent Chemotherapy ( CAPTEM regimen in patients with well and moderately differentiated neuroendocrine tumors. Since Liver is a critical organ , delivery of PRRT to liver will result in higher dose and prolonged retention of isotope in the metastases, resulting in better outcomes.
Materials and methods: Patients with unresectable treatment refractory disease with normal liver and renal functions were treated using Luteitium 177 Dotatate. One hundred sixty two patients with well or moderately differentiated neuroendocrine tumors were evaluated. Ninety four patients with metastatic, unresectable or functioning tumors were treated with intravenous PRRT alone . Sixty eight patients were treated with Liver directed PRRT along with CAPTEM regimen.
Primary endpoint: Progression-free survival (PFS) from day end of PRRT to progression of disease or death was assessed using Kaplan Meier Analysis. Safety evaluation included incidence of nephro, hemato and hepatotoxicity during infusion and subsequent follow up period.
Results: The mean progression free survival with intraarterial PRRT with chemotherapy was 49.6 months (95% CI 5.5 to 38.8) compared to 12.9 months (95%CI 2.1 to 8.9) for IVPRRT alone (Log rank χ2=42.1, p<0.001). There were no toxicity events.
Conclusions: Procedure is well tolerated , safe and the data suggests encouraging results with liver directed PRRT and CAPTEM chemotherapy without significant toxicity.