Surgery in Combination with Peptide Receptor Radionuclide Therapy: A Novel Approach for the Treatment of Advanced Neuroendocrine Tumours

Neuroendocrine tumours/neoplasms (NEN) are clinically challenging entities, often due to their late stage at initial diagnosis. Whilst surgery is the cornerstone of curative treatment, many patients are not eligible for a radical surgical approach, and instead other targeted or systemic treatments may be utilised. Neoadjuvant concepts such as downstaging borderline resectable tumours are more established in some adenocarcinomas than in neuroendocrine oncology, yet the diverse armamentarium for the latter offers promise for novel multimodal concepts that may offer prolonged disease control by complementarily targeting micro- and macro-neuroendocrine disease. One promising option, as yet only explored in small case series, is the combination of surgery and peptide receptor radionuclide therapy (PPRT). Here, the authors review the challenges posed by advanced NEN, review the fledgling evidence regarding the combination of PRRT and surgery, and present the case for a wider examination of embedding PRRT and surgery within a multimodal treatment strategy.