Additionally, one prospective controlled trial currently has investigated the safety of neoadjuvant radioligand therapy before surgery.70 The 2024 NEOLUPANET multicenter, single-arm phase 2 trial of patients with sporadic NF-PNETs harboring at least one high-risk feature (tumor size > 4 cm, Ki-67 index > 10 %, adjacent organ involvement or vascular invasion) enrolled 31 patients treated with four cycles of 177Lutetium-DOTATATE before surgery. Here, MKI67 is linked to neoplasm.