Managing Neuroendocrine Tumors in Interventional Radiology w/ Dr. Daniel DePietro | Ep. 602

What considerations drive your decision between bland embolization, TACE, and radioembolization in managing neuroendocrine tumors? In this BackTable episode, Dr. Daniel DePietro, interventional radiologist at the University of Pennsylvania joins host Dr. Kavi Krishnasamy for an in-depth discussion on the interventional management of neuroendocrine tumors. --- This podcast is supported by: RADPAD® Radiation Protection https://www.radpad.com/ --- SYNPOSIS The physicians start by discussing the intricacies of primary and metastatic neuroendocrine tumors, focusing on how treatment decisions are shaped by factors such as symptom burden, extent of disease requiring debulking, and symptom progression despite systemic therapy. Dr. DePietro shares insights from his clinical experience and emphasizes the critical role of interdisciplinary collaboration in optimizing patient outcomes. Dr. DePietro then shares his approach to using Y90 radioembolization in patients with biliary contraindications to TACE or bland embolization—such as those with prior Whipple surgery, sphincterotomy, or biliary stents—where the risk of hepatic abscess with ischemia-based therapies is higher. He also notes that patients who derive less than a year of benefit from prior TACE or bland embolization may be good candidates for radioembolization. The conversation also covers the role of thermal ablation in select patients with solitary lesions, and also touches on several key trials, including the ongoing CapTemY90 study. --- TIMESTAMPS 00:00 - Introduction 02:09 - Specialization in Neuroendocrine Tumors 06:32 - Patient Selection and Treatment Criteria 10:40 - Grading and Treatment of Neuroendocrine Tumors 16:09 - Systemic Therapy Options 22:22 - Rebiopsy and Its Importance 28:01 - Technical Aspects of Local Regional Therapies 39:14 - Radioembolization: When and How 43:33 - Segmentectomy and Multimodal Approaches 45:22 - CapTemY90 Trial and Promising Results 49:52 - Hormone Release During Local Regional Therapies 53:12 - Combining Radioembolization with PRT 56:12 - Thermal Ablation in Neuroendocrine Tumor Patients 58:06 - Follow-Up Imaging and Tumor Markers 01:02:40 - Updates from Nanets Conference 01:05:08 - Collaborating Across Specialties 01:07:56 - Managing High Tumor Burden Patients 01:13:59 - Treating Carcinoid Heart Disease 01:19:37 - Closing Remarks and Acknowledgments --- RESOURCES NETTER-1 Trial https://www.nejm.org/doi/full/10.1056... REMINET Trial https://ascopubs.org/doi/10.1200/JCO.... CapTemY90 Trial https://www.clinicaltrials.gov/study/... --- The BackTable Podcast is a resource for interventional radiologists, vascular surgeons, interventional cardiologists, and other interventional and endovascular specialists to learn tips, techniques, and the ins and outs of the devices in their cabinets. Get notified when new episodes drop! Subscribe to the BackTable Podcast on your go-to podcast platform, and follow us on your social media platform of choice for regular vascular and interventional updates. ► https://www.backtable.com/shows/vi/su... #VI602 #interventionalradiology #oncology #ablation