neo-adjuvant systemic radiation therapy for inoperable hepatic hilum neuroendocrine tumor with 177lu- dotatate: successful final surgical resection

The role of neoadjuvant therapy in neuroendocrine tumors (net) remains an area requiring further advanced clinical exploration. 177lu-dotatate has demonstrated significant therapeutic efficacy in managing metastatic net, with reports of notable tumor size reduction in specific cases. this report highlights the case of a young patient diagnosed with an initially inoperable hepatic hilum net. the patient received two cycles of 177lu-dotatate, resulting in remarkable tumor shrinkage on follow-up imaging, which facilitated surgical intervention. the patient underwent a complex left trisectionectomy resection, including anastomosis of the right portal vein, resection and interposition graft of the right hepatic artery, roux-en-y hepaticojejunostomy, and jejunojejunostomy. due to residual involvement of the common hepatic duct and right portal vein margins, two additional cycles of adjuvant 177lu-dotatate were administered post-surgery. long-term follow-up imaging over a 20-month period has demonstrated stable disease, emphasizing the potential benefits of incorporating neoadjuvant and adjuvant 177lu-dotatate in selected net cases.