ECE2013 Poster Presentations Endocrine tumours and neoplasia (66 abstracts)
Therapy with 177Lu marked somatostatin analogues in a case of pancreatic metastatic neuroendocrine tumor
Sandra Belo 1, , Ines Lucena 2 , Ana Paula Santos 3 , Luis Pedro Afonso 4 , Cristina Sanches 5 & Hugo Duarte 2
1Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar de São João, Porto, Portugal; 2Department of Nuclear Medicine, Instituto Portugues de Oncologia, Porto, Portugal; 3Department of Endocrinology, Instituto Portugues de Oncologia, Porto, Portugal; 4Department of Pathology, Instituto Portugues de Oncologia, Porto, Portugal; 5Department of Neuroendocrine Surgery, Instituto Portugues de Oncologia, Porto, Portugal; 6Faculty of Medicine, University of Porto, Porto, Portugal.
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 (40–450), A5HI 3.7 ng/24 h (2.0–10), chromogranin A (CgA) 286 ng/ml (<134), gastrin 118 ng/ml (<108), insulin 6.43 μUI/ml (6–30) and glucagon 472 pg/ml (100–190). Patient underwent body-caudal pancreatectomy. Histology revealed well differentiated pancreatic NET, G2, 2–10 mitoses/HFA, Ki67 3–20%, 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.
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