Therapeutic Efficacy of Neoadjuvant Peptide Receptor Radionuclide Therapy in Neuroendocrine Tumors

PURPOSE: Peptide receptor radionuclide therapy (PRRT) has an established role in the management of metastatic neuroendocrine tumors (NETs); however, the potential benefits of neoadjuvant PRRT remain insufficiently characterized. This study aimed to evaluate the therapeutic efficacy of neoadjuvant PRRT in patients with NETs through a meta-analysis. PATIENTS AND METHODS: A systematic database search of PubMed, EMBASE, and the Cochrane Library was performed using the keywords "neuroendocrine tumor," "neoadjuvant therapy," and "peptide receptor radionuclide therapy." Pooled proportions of objective response rate (ORR), disease control rate (DCR), surgical resection rate (SRR), and R0 resection rate (RRR) were calculated to assess therapeutic efficacy. Subgroup analyses were conducted to explore the influence of primary NET resectability. RESULTS: A total of 237 patients from 10 studies were included. Neoadjuvant PRRT achieved ORR of 39.1% (95% CI, 21.0%-59.0%), DCR of 89.0% (95% CI, 78.5%-96.3%), SRR of 51.7% (95% CI, 31.1%-72.1%), and RRR of 69.0% (95% CI, 59.9%-77.1%). Subgroup analysis indicated that therapeutic efficacy was comparable regardless of primary NET resectability (ORR, DCR, and RRR). CONCLUSIONS: Neoadjuvant PRRT appears to be an effective therapeutic strategy for patients with NETs, particularly by reducing tumor size and stage in borderline resectable or unresectable cases. These findings suggest that neoadjuvant PRRT represents a promising option to facilitate surgical resection and improve outcomes in NET patients.