BackTable Vascular & Interventional Ep. 602 Managing Neuroendocrine Tumors in Interventional Radiology with Dr. Daniel DePietro
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Dec 30, 2025 Dr. Daniel DePietro, an interventional radiologist and neuroendocrine tumor specialist at the University of Pennsylvania, discusses the complexities of managing neuroendocrine tumors. He shares insights on deciding between bland embolization, TACE, and radioembolization based on patient needs and prior treatments. The conversation also covers the importance of multidisciplinary collaboration, the role of thermal ablation for select patients, and updates on ongoing clinical trials that explore innovative liver-directed therapies.
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When Y90 Outweighs Ischemic Embolization
- Radioembolization is preferred for patients with biliary contraindications to ischemia-based therapies like prior Whipple, sphincterotomy, or biliary stents.
- Also consider Y90 when prior embolization offered <1 year benefit or when patients cannot tolerate post-embolization syndrome.
Use Multi-Compartment Y90 Dosimetry
- Use multi-compartment partition dosimetry for NET Y90 and dose to normal liver, not just tumor, when possible.
- Measure volumes in planning software and adjust particle count and activity by vascularity and tumor distribution.
CAPTEM + Y90 Shows Promising Outcomes
- Combining CAPTEM with Y90 produced unusually high hepatic objective response and long hepatic PFS in Penn data (single-center and multicenter accrual ongoing).
- The grade‑3 arm will use partition dosimetry rather than BSA going forward.