BackTable Vascular & Interventional Ep. 602 Managing Neuroendocrine Tumors in Interventional Radiology with Dr. Daniel DePietro
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.
AI Snips
Chapters
Transcript
Episode notes
When To Offer Liver-Directed Therapy
- Treat liver-only or liver-dominant NETs when they cause hormonal symptoms, pain, or threaten liver failure from high tumor burden.
- Prioritize embolization for symptomatic control, debulking before systemic therapy, or progression despite SSAs.
Ki-67 Shapes NET Treatment Strategy
- Ki-67 measures proliferation and stratifies NETs into grades 1–3 based on thresholds (<3%, 3–20%, >20%).
- Well-differentiated vs poorly differentiated tumors change treatment expectations despite overlapping KI-67.
Start With SSAs And Plan Multimodally
- Always consider somatostatin analogs for somatostatin-receptor–positive NETs and continue them even after progression.
- Include surgery, embolization, ablation, and systemic options in a multimodal plan tailored by grade.