Introduction: Conventional systemic therapies have limited role in metastasized neuroendocrine tumors (NET). Therefore an increasing role is attributed to 177Lu labeled somatostatin analogues (SA).
Case: Man, 52 years, referred because of NET, diagnosed following liver biopsy for hepatic nodules (liver tissue infiltrated by NET, compatible with metastases). Endoscopic ultrasound revealed pancreatic nodular formation, 40×24 mm; 99mTc scintigraphy revealed foci of hyperfixation in the liver, midline abdominal projection and left kidney upper pole. Serotonin levels were 183.0 ng/ml (40450), A5HI 3.7 ng/24 h (2.010), chromogranin A (CgA) 286 ng/ml (<134), gastrin 118 ng/ml (<108), insulin 6.43 μUI/ml (630) and glucagon 472 pg/ml (100190). Patient underwent body-caudal pancreatectomy. Histology revealed well differentiated pancreatic NET, G2, 210 mitoses/HFA, Ki67 320%, peri-pancreatic soft tissue, lymphovascular and perineural invasion, lymph nodes metastasis, positivity for Cam52, CgA, synaptophysin and NES. 68Ga-DOTANOC-PET revealed liver, lumbo-aortic, periceliac lymph nodes foci of hyperfixation. Embolization of liver metastases and SA treatment was started. Second 68Ga-DOTANOC-PET revealed new hepatic foci. Because of disease progression therapy with 177Lu-DOTATATE was preformed. 68Ga-DOTANOC-PET after three cycles of 177Lu revealed fewer liver foci and no evidence of adenopathy.
Conclusion: Treatment with radiolabelled SA is a promising strategy in patients with inoperable or metastatic NET.