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Questions for surgeon-considerations choosing PRRT or surgery

Posted by splendrous @splendrous, 1 day ago

I am considering surgery for neuroendocrine tumors metastatic to the liver. I have about 6-7 tumors that are visible on MRI. One surgeon told me he was certain that he would find more once he was in the surgery. He uses ultrasound in addition to his fingers to find additional tumors in the intestine as well as the liver. Would appreciate any suggestions on what I should ask a surgeon to find the best one for me and to understand potential adverse effects and recovery. I know there is more recovery in surgery than PRRT, but would surgery be able to remove more tumors? Thanks for sharing.

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zacharycat | @zacharycat | 22 hours ago

There's a good chance of you having both treatments when all is said and done. For me they used PRRT first to reduce the tumor size. There was still plenty left for the surgeon though - tail of the pancreas, spleen and gallbladder plus liver ablation. Other times they do surgery first then use PRRT or chemotherapy later.

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splendrous | @splendrous | 22 hours ago

Thanks for sharing. What was the size of your larger tumors? What type of ablation did you have? They did not need to surgically remove any of the tumors from the liver they were able to remove them with ablation? Who did your surgery?

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dbamos1945 | @dbamos1945 | 18 hours ago

@splendrous: I was in similar situation last year. If I were you I would get Gallium 68 PET scan to reveal tumors reactive to PRRT targeting. I believe PRRT can eliminate small tumors and reduce size of larger ones - that’s the response I got from Lutathera PRRT and it continues to reduce tumor size with three MRI Evoist scans since the final treatment Dec 2024! We NET patients are all different. After the GA68 PET results I would get 2nd NET Oncologist expert consultation & also 2nd opinion from NET surgeon. Of course we all lean towards the less invasive treatment and may choose to avoid complications resulting from surgery; however, we also want longest-lasting tumor control. The more info you accumulate I think will lead you to your best decision. My best thoughts are with you! dbamos1945

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zacharycat | @zacharycat | 6 hours ago
In reply to @splendrous "Thanks for sharing. What was the size of your larger tumors? What type of ablation did..." + (show)
Profile picture for splendrous @splendrous

Thanks for sharing. What was the size of your larger tumors? What type of ablation did you have? They did not need to surgically remove any of the tumors from the liver they were able to remove them with ablation? Who did your surgery?

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Surgery was done at Trinity Hospital in Ann Arbor Mich, not at Mayo. All my treatment was there except for PRRT at University of Michigan cancer center.
The primary tumor was pancreatic, about 1.5 to 2 cm as I recall. They did liver ablation with radio frequency but didn't surgically remove anything from the liver so far as I know. The chart says they focused on two large masses in the liver and had "excellent results". Later in the report the surgeon says "No real surprises, just what we expected." Well before any of these other treatments they had also done a hepatic artery embolization to block the blood supply to the tumors.

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