1. Treatment of Oligometatic PNET Mets to Liver Following Resection
Michael Nichols, MD
Andrew J. Lipnik, MD
Bryan Hartley, MD
Daniel B. Brown, MD, FSIR
Vanderbilt University Interventional Oncology

2. History
2013: 53 y/o F with pancreatic head mass detected on workup for refractory hyperglycemia
2.7 x 2.1 cm pancreatic head mass with periportal and retroperitoneal adenopathy, and several suspected liver metastases
2014: Patient underwent laparoscopic pancreaticoduodenectomy, portal lymphadenectomy, and resection of lesions in liver segments 1, 5, and 7.
Low grade tumor by path
Ki-67: 1%

3. Additional History
CT obtained 4 months post-op demonstrated new 2.1 cm lesion in hepatic segment 5, suspicious for PNET metastasis.
The patient had a prolonged recovery from surgery and was referred to Interventional Oncology Clinic

4. Post-operative Imaging

5. Biopsy performed Confirmed diagnosis of metastatic PNET
Ki-67: 15%
Discussed risks (abscess) and options including
Observation
Ablation
Patient elected to wait
Still recovering from surgery

6. 3 Months Later No change in size Patient now amenable
Moxifloxacin prep started

7. MWA of Lesion in Segment 5
Two 19-gauge PR antennae
5 minute ablation at 65 watts
3 additional minutes at 60 watts after retracting antennae 1 cm each
After 5 min

8. MWA Final imaging demonstrates a margin of least 1.2 cm on all sides
Patient recovered without infectious complications

9. Questions
In this patient, should immediate intervention been performed without symptoms? If not, what would trigger you to treat?
What treatment options should be considered in this case? Surgical, medical, interventional, other?
Does the relatively short disease-free interval following surgery change your approach to treatment of a new liver metastasis?
The primary tumor had a lower grade and Ki-67% than the metastasis. How do you incorporate these values into your approach?