Endocrine Abstracts

Introduction: Palliative radiotherapy is an important treatment modality for patients with metastatic neuroendocrine tumours which has often been used to improve symptoms from bone and nodal metastases. We describe the effective use of palliative radiotherapy for subcutaneous metastases in a patient with large cell neuroendocrine carcinoma.

Case Presentation: A 67-year-old presented to the Head and Neck service with a 6-year history of progressive dysphagia. Clinical examination revealed multiple skin lesions on the torso and a flexible nasendoscopy identified an abnormal epiglottis. Both areas were biopsied. Skin biopsy was positive for TTF-1, chromogranin A and CD56. Ki67 was 20% with a large cell morphology. Diagnosis of metastatic large cell neuroendocrine carcinoma is favoured. Both left and right epiglottis were biopsied with chronic inflammation seen, no evidence of malignancy. Gallium 68 DOTATOC scan and FDG PET CT scan both recorded activity in the epiglottis and multiple subcutaneous nodules. August 2020 - Completed 3 cycles of carboplatin and Etoposide. Progressive disease on CT scan upon completion of treatment. October 2020 - Painful right flank and back lesions. 20Gy in 5 fractions radiotherapy delivered with good clinical response. Started monthly SSA injections alongside this. April 2021 - Completed 8 cycles of CAPTEM with stable disease on CT scan. January 2022 – New enlarging cervical and SCF nodes. 20Gy in 5 fractions delivered to left neck including epiglottis with good response demonstrated both clinically and radiologically. Between 2022 – 2024 – Further palliative radiotherapy (8Gy single fractions) delivered to painful areas in left thigh and right axilla achieving clinical benefit. Otherwise well and clinically stable during this period. September 2024 – presented with neurological signs and found to have a solitary malignant brain tumour. He deteriorated rapidly and died in November 2024.

Conclusion: There is clear benefit in using palliative radiotherapy in addition to systemic anti-cancer therapies in the management of cutaneous metastatic large cell neuroendocrine tumours to provide local control and symptomatic benefit.