Selective Intra-arterial Injection of PRRT in Neuroendocrine Tumor Patients With Liver Metastases

Inclusion Criteria:

* Ability to understand and the willingness to provide informed consent
* Pathologically well-differentiated neuroendocrine tumor (i.e. grade 1 or grade 2).
* Primary tumor location should be known or believed to be midgut.
* At least one tumor in the liver that is positive with \[68\]Ga-DOTATATE (NETSPOT). Imaging must be performed within the past 6 months.
* Liver lesions not amendable to other therapies (surgery, ablation) and have progressed after treatment with octreotide/lanreotide and/or other treatments. (everolimus, sunitinib).
* Karnofsky performance status of at least 70
* Absolute neutrophil count of at least 1,000 cells/mm3
* Platelet count of at least 90,000 cells / mm3
* Total bilirubin ≤ 2 x the upper limit of normal when adjusted for age
* AST and ALT ≤ 5 x the upper limit of normal when adjusted for age
* Serum creatinine ≤ 1.2 mg/dl; if serum creatinine is \>1.2 mg/dl nuclear GFR will used for potentially eligible participants.
* Agrees to contraception.

Exclusion criteria:

* Liver tumor involvement greater than 70% by cross sectional imaging
* Extra-hepatic visceral and osseous metastases
* Concomitant therapy for tumor (except for somatostatin analogs or bisphosphonates)
* Previous PRRT or other liver directed therapy within 12 months of consent
* Women who are pregnant, breast feeding or breast pumping.
* Another concurrent malignancy on active therapy
* Previous external-beam radiation therapy to a kidney (including scatter dose)
* Therapeutic investigational drug within 4 weeks of therapy.
* Subjects for whom, in the opinion of their physician, a 24-hour discontinuation of somatostatin analogue therapy represents a health risk.
* Sandostatin LAR injection within 4 weeks or lanreotide injection within 8 weeks of proposed therapy.
* Inability to lie down supine for study procedure.
* Reaction to IV contrast used for the angiogram.
* Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection requiring hospitalization, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements