A group from Australia (Barber et al. 2012) used ¹⁷⁷Lu-octreotate as neoadjuvant treatment. There were five patients, four with a primary nonfunctioning pancreatic neuroendocrine tumor and one with a locoregional recurrence of a duodenal tumor. Four patients had disease confined to local/locoregional sites, and one patient had also solitary liver metastases. Four patients with primary PNT were treated with four cycles of ¹⁷⁷Lu-DOTATATE with administered activity ranging from 7 to 10 GBq, at 6- to 8-week intervals. The subsequent three cycles of PRRT were administered with a concurrent radiosensitizing dose of infusional 5FU chemotherapy (200 mg/m²/24 h) commencing 4 days prior and continuing for a total of 3 weeks. The remaining patient with a locoregional duodenal NET recurrence was treated with one cycle of ¹⁷⁷Lu-DOTATATE, which was administered 3 weeks prior to previously planned external-beam radiotherapy (45 Gy in 25 fractions) to maximize the radiation dose delivered to the tumor. The patient received also concurrent 5FU chemotherapy. At 3 months post treatment, all five patients had scintigraphic response, four had radiological response, and three of the four symptomatic patients responded clinically. All five patients had ongoing treatment response beyond 3 months, including the one whose further tumor shrinkage facilitated curative surgery (6 months after completion of treatment). Complete resection was performed subsequently. Histological examination demonstrated a Ki67 index of 5%, which was lower than in the biopsy before surgery. The patient with distant metastases had ongoing complete scintigraphic and radiological response of the solitary liver metastasis at 18-month follow-up. The remaining patients were deemed unsuitable for curative resection due to medical comorbidities (two patients), ongoing technical surgical difficulties (one patient), and patient choice (one patient).