Megawer, Rana

Abstract Introduction: Lutetium-177 DOTATATE peptide receptor radionuclide therapy (PRRT) is an effective treatment for gastroenteropancreatic neuroendocrine tumors (GEP-NETs). While generally well tolerated, PRRT can result in hematologic toxicity ranging from mild cytopenias to therapy-related myeloid neoplasms (t-MNs). Understanding the incidence, severity, and clinical consequences of hematologic toxicity is essential for optimizing treatment decisions and establishing effective monitoring strategies. This study aimed to characterize hematologic toxicity patterns, severity, and recovery profiles in GEP-NET patients treated with Lutetium-177 DOTATATE PRRT and to determine the frequency of cytopenia-related treatment discontinuation. Methods: We conducted a retrospective analysis of 160 consecutive GEP-NET patients who underwent PRRT. Hematologic parameters (hemoglobin, white blood cell count, absolute neutrophil count, platelet count, and lymphocyte count) were assessed at baseline, mid-treatment (post-cycle 2), and post-treatment (post-cycle 4). Cytopenias were graded using Common Terminology Criteria for Adverse Events version 4.03 and categorized as never (grade <2 throughout), transient (grade ≥2 mid-treatment, resolving post-treatment), persistent (grade ≥2 at both timepoints), or late-onset (grade <2 mid-treatment, grade ≥2 post-treatment). Treatment completion rates and discontinuation reasons were documented. Results: Overall, 73% of patients (117/160) completed all planned PRRT cycles. Among the 43 patients who discontinued treatment early, only 4 (2.5% of total cohort) discontinued specifically due to cytopenia, while the remainder discontinued for other reasons. Post-treatment grade ≥2 cytopenias were uncommon: lymphocytes (4.4%), hemoglobin (2.5%), neutrophils (1.9%), white blood cells (1.3%), and platelets (1.3%). The majority of patients (≥85%) never experienced grade ≥2 cytopenia throughout treatment. When cytopenias occurred, they were predominantly transient (8-10% of patients) with complete recovery by treatment completion. Persistent cytopenias were rare (<5% across all cell lines), while late-onset cytopenia occurred most frequently with neutrophils (14%). Conclusion: Lutetium-177 DOTATATE PRRT demonstrates an excellent hematologic safety profile in GEP-NET patients. Severe cytopenias are uncommon, predominantly transient, and rarely necessitate treatment discontinuation. These findings support the continued use of PRRT in appropriate candidates, with cytopenia-related discontinuation occurring in fewer than 3% of cases. Long-term follow-up remains essential to monitor delayed hematologic effects, including t-MNs. Future research should evaluate baseline predictors such as prior chemotherapy, renal function, and marrow reserve to identify patients at higher risk who may benefit from closer hematologic surveillance.

Abstract Background Endoscopic placement of self-expandable metal stents (SEMS) is a minimally invasive intervention, aiming to restore luminal patency in GIT obstruction patients. As stent migration is considered a major sequela, techniques for its fixation have been established. This study aims to assess the efficacy of stent fixation using either endoscopic suture fixation or over-the-scope clips (OTSC). Methods Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we searched available databases (PubMed, Scopus, and Web of Science) to identify eligible studies reported up to January 2025. Using RevMan 5.4, we reported outcomes as odds ratios (OR) and confidence intervals (CIs). A P-value ≤ 0.05 was considered statistically significant. Results Twelve studies were included in this meta-analysis, with a total of 1136 patients. The pooled OR for stent fixation is 0.32 (95% CI: 0.19–0.57; p < 0.001), with moderate heterogeneity (I² = 59%, P = 0.005). According to the subgroup analysis in relation to the fixation method, suture fixation yields a pooled OR of 0.37 (95% CI: 0.19–0.69; p = 0.002), and OTSC fixation yields a pooled OR of 0.25 (95% CI: 0.11–0.54; p = 0.0004). There is no statistically significant difference between these subgroups (p = 0.45, I² = 0%). There was no statistically significant difference in the rates of adverse events; with a pooled OR of 0.71 (95% CI: 0.33–1.54), and substantial heterogeneity (I 2 = 73%; P = 0.002). Conclusion Statistically significant lower stent migration rates were reported following either endoscopic suture fixation or OTSC, along with higher clinical success rates. Future clinical trials with longer follow-up durations are recommended to accurately update the guidelines.