Ten-Year Survival After Peptide Receptor Radionuclide Therapy of a Metastatic Well-differentiated G3 Pancreatic Neuroendocrine Neoplasm

2018 ◽  
Vol 43 (9) ◽  
pp. 676-678 ◽  
Author(s):  
Jingjing Zhang ◽  
Harshad R. Kulkarni ◽  
Aviral Singh ◽  
Richard P. Baum
Keyword(s):  
Radionuclide Therapy ◽  
Peptide Receptor Radionuclide Therapy ◽  
Neuroendocrine Neoplasm ◽  
Peptide Receptor ◽  
Pancreatic Neuroendocrine Neoplasm ◽  
Well Differentiated

scholarly journals Neoadjuvant peptide receptor radionuclide therapy and modified multivisceral transplantation for an advanced small intestinal neuroendocrine neoplasm: an updated case report

2017 ◽  
Vol 2 (4) ◽  
pp. 247-253
Author(s):  
Ashley K. Clift ◽  
Henk Giele ◽  
Srikanth Reddy ◽  
Rubens Macedo ◽  
Adil Al-Nahhas ◽  
...  
Keyword(s):  
Radionuclide Therapy ◽  
Surgical Techniques ◽  
Peptide Receptor Radionuclide Therapy ◽  
Neuroendocrine Neoplasm ◽  
Peptide Receptor ◽  
Multivisceral Transplantation ◽  
First Case ◽  
Mesenteric Root ◽  
Number Of Patients ◽  
Small Intestinal

AbstractSmall intestinal neuroendocrine neoplasms (SI-NEN) frequently metastasise to regional lymph nodes, and surgery is the mainstay of therapy for such patients. However, despite the possible use of advanced surgical techniques, the resection of both primary and locoregional diseases is not always attainable. Intestinal and multivisceral transplantation has been performed in a small number of patients with conventionally nonresectable, slow-growing tumours threatening the mesenteric root but has remained controversial. The use of donor skin in “sentinel flaps” in transplantation theoretically offers advantages in tailoring immunosuppression and monitoring for rejection. We represent (with extended follow-up) the first case of a patient with inoperable extensive mesenteric metastases from SI-NEN, who underwent neoadjuvant peptide receptor radionuclide therapy before a modified multivisceral transplant with a concomitant vascularised sentinel forearm flap. At 48 months after transplantation, our patient remained at full physical activity with no evidence of disease recurrence on either tumour biochemistry or radiological imaging.

Effectiveness of peptide receptor radionuclide therapy for neuroendocrine neoplasms: A multi-institutional registry study with prospective follow-up.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 4033-4033
Author(s):  
Dieter Hörsch ◽  
Keyword(s):  
Small Bowel ◽  
Radionuclide Therapy ◽  
Peptide Receptor Radionuclide Therapy ◽  
Progression Free Survival ◽  
Unknown Primary ◽  
Neuroendocrine Neoplasms ◽  
Registry Study ◽  
Free Survival ◽  
Peptide Receptor ◽  
Well Differentiated

4033 Background: Peptide receptor radionuclide therapy targets somatostatin receptors expressed on well differentiated neuroendocrine neoplasms. Retrospective monocentric studies indicate that peptide receptor radionuclide therapy is an effective treatment for patients with neuroendocrine neoplasms. Methods: We initiated a multi-institutional, prospective and board reviewed registry study for patients treated with peptide receptor radionuclide therapy. 450 patients were included and followed for a mean of 24.4 months. Patients were treated with Lutetium-177 (54%), Yttrium-90 (17%) or both radionuclides (29%). Primary neuroendocrine neoplasms were derived of pancreas (38%), small bowel 30%), unknown primary (19%), lung (4%) and colorectum (3,5%). Most neuroendocrine neoplasms were well differentiated with a proliferation rate below 20% in 54% and were pretreated by 1 or more therapies in 73%. Results: Overall survival of all patients from the beginning of therapy was 59 months in median. Median survival depended on radionuclides used (Yttrium-90: 38 months; Lutetium-177: not reached; both: 58 months), proliferation rate (G1: median not reached; G2: 58 months; G3: 33 months; unknown: 55 months) and origin of primary tumors (pancreas: 53 months; small bowel: not reached; unknown primary: 47 months; lung: 38 months) but not upon number of previous therapies. Median progression-free survival measured from last cycle of therapy accounted to 41 months for all patients. Progression-free survival of pancreatic neuroendocrine neoplasms was 39 months in median. Similar results were obtained for neuroendocrine neoplasms of unknown primary with a median of 38 months whereas neuroendocrine neoplasm of small bowel were progression-free for a median of 51 months. Side effects like G3-G4 nephrotoxicity or hematological function were observed in 0.2% and 2% of patients. Conclusions: Peptide receptor radionuclide therapy is effective for patients with G1-G2 neuroendocrine tumors irrespective of previous therapies with a survival advantage of several years compared to other therapies and only minor side effects.

Severe metabolic acidosis and hyperkalemia after peptide receptor radionuclide therapy. A case report, review of the literature and proposed treatment algorithm

2021 ◽  
pp. 239936932110197
Author(s):  
Nikolaos A Trikalinos ◽  
Hyun Kim ◽  
Amir Iravani ◽  
Lauren Henke ◽  
Anitha Vijayan
Keyword(s):  
Radionuclide Therapy ◽  
Treatment Algorithm ◽  
Peptide Receptor Radionuclide Therapy ◽  
Neuroendocrine Neoplasms ◽  
Review Of The Literature ◽  
Peptide Receptor ◽  
Life Threatening ◽  
Well Differentiated ◽  
Intravenous Sodium ◽  
Electrolyte Abnormalities

Peptide receptor radionuclide therapy (PRRT) has been increasingly used in the treatment of patients with well-differentiated neuroendocrine neoplasms (WD-NENs), but electrolyte abnormalities during prophylactic aminoacid (AA) infusion can complicate its administration. We describe a case of AA-induced acidosis and hyperkalemia associated with PRRT. We tailored an oral and intravenous sodium bicarbonate regimen for pre-emptive treatment prior to subsequent PRRT session, thereby preventing hospitalization. We provide a relevant review of the literature and our treatment algorithm, that can serve as a point of reference in treatment of this life-threatening complication of PRRT.

scholarly journals Peptide receptor radionuclide therapy controls inappropriate calcitriol secretion in a pancreatic neuro-endocrine tumor: a case report

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Maarten Haemels ◽  
Thierry Delaunoit ◽  
Koen Van Laere ◽  
Eric Van Cutsem ◽  
Chris Verslype ◽  
...  
Keyword(s):  
Liver Metastases ◽  
Neuroendocrine Tumor ◽  
Neuroendocrine Tumors ◽  
Serum Calcium ◽  
Radionuclide Therapy ◽  
Active Form ◽  
Peptide Receptor Radionuclide Therapy ◽  
Pancreatic Neuroendocrine Tumor ◽  
Neuroendocrine Neoplasm ◽  
Peptide Receptor

Abstract Background Hypercalcemia of malignancy is not uncommon in patients with advanced stage cancer. In rare cases the cause of the hypercalcemia is excessive production of calcitriol, the active form of vitamin D. Although inappropriate tumoral secretion of calcitriol is typically associated with lymphomas and some ovarian germ cell tumors, we present a case of calcitriol overproduction-induced hypercalcemia due to a pancreatic neuroendocrine tumor. The high expression of somatostatin receptors on this neuroendocrine neoplasm opened up the opportunity to treat the patient with radiolabelled somatostatin analogs, which successfully controlled the refractory hypercalcaemia and calcitriol levels. This case documents a rare finding of refractory hypercalcaemia of underlying malignancy due to a calcitriol-producing pancreatic neuroendocrine tumor, responding to peptide receptor radionuclide therapy (PRRT). Case presentation A 57 years-old patient presented with back pain, general discomfort, polydipsia, polyuria, fatigue and recent weight loss of 10 kg. Clinical examination was normal and there was no relevant medical history. Biochemical evaluation showed hypercalcemia with markedly increased calcitriol levels. CT-thorax-abdomen and ultrasound guided biopsy revealed a pancreatic neuroendocrine tumor with multifocal liver metastases, suggesting that excessive overproduction of calcitriol by this neuroendocrine tumor was the cause of the refractory hypercalcemia. The patient was eligible for PRRT. Four cycles of 177Lu-DOTATATE PRRT resulted in a morphological response and a normalization of serum calcium levels, confirming the hypothesis of a calcitriol producing pancreatic neuroendocrine tumor. Progression of liver metastases warranted further therapy and temozolomide-capecitabine was started with morphological and biochemical (serum calcium, calcitriol) stabilization. Conclusion Although up to 30–40% of gastroenteropancreatic neuroendocrine tumors are known to be functional (i.e. producing symptoms associated with the predominant hormone/peptide secreted), calcitriol secreting pancreatic neuroendocrine tumors are very rare. However, treatment with PRRT resulted in normalization of calcium and calcitriol levels, strongly supporting the hypothesis of a calcitriol-producing pancreatic neuroendocrine tumor.

scholarly journals Peptide Receptor Radionuclide Therapy Outcomes in a North American Cohort With Metastatic Well-Differentiated Neuroendocrine Tumors

Pancreas ◽  
2017 ◽  
Vol 46 (2) ◽  
pp. 151-156 ◽  
Author(s):  
Nancy Sharma ◽  
Boris G. Naraev ◽  
Eric G. Engelman ◽  
M. Bridget Zimmerman ◽  
David L. Bushnell ◽  
...  
Keyword(s):  
Neuroendocrine Tumors ◽  
North American ◽  
Radionuclide Therapy ◽  
Peptide Receptor Radionuclide Therapy ◽  
Therapy Outcomes ◽  
Peptide Receptor ◽  
Well Differentiated ◽  
North American Cohort

scholarly journals Treatment with somatostatin analogues and PRRT in metastatic middle ear adenoma with neuroendocrine features

2021 ◽  
Vol 2021 ◽  
Author(s):  
Joana Lima Ferreira ◽  
Bernardo Marques ◽  
C Willemien Menke-van der Houven van Oordt ◽  
Wouter W de Herder ◽  
Tessa Brabander ◽  
...  
Keyword(s):  
Middle Ear ◽  
Stable Disease ◽  
Radionuclide Therapy ◽  
Peptide Receptor Radionuclide Therapy ◽  
Somatostatin Analogues ◽  
Peptide Receptor ◽  
Pet Ct ◽  
Middle Ear Adenoma ◽  
Well Differentiated ◽  
Long Acting

Summary Middle ear adenomas with neuroendocrine features (ANEF) are rare, with an estimated 150 reported cases. They usually pursue an indolent clinical course. Four reported cases of middle ear ANEF with distant metastases were treated with surgery, external beam radiation therapy (EBRT) and chemotherapy. To date, no successful systemic treatment for malignant behaviour of this rare tumour has been reported. Long-acting somatostatin analogues (SSAs) and peptide receptor radionuclide therapy (PRRT) have been used in well-differentiated metastatic neuroendocrine tumours (NETs), but their use has never been described in cases of metastatic middle ear ANEF. We report two patients with grade 1 middle ear ANEF treated with surgery and EBRT. They had stable disease for several years, until clinical symptoms appeared and extensive metastases were detected on 68Ga-DOTA0-Tyr3-octreotate (DOTATATE) PET/CT. Treatment with long-acting SSA was started, with stable disease for 1 year. Afterwards, despite undergoing local treatments, both patients presented progressive disease. Due to high-uptake metastases at 68Ga-DOTATATE PET/CT, both cases underwent four cycles of PRRT with 177Lu-DOTATATE, which secured disease control and improvement of quality of life in both. Similar to other well-differentiated NETs, SSA and PRRT could constitute efficacious therapeutic options in metastatic middle ear ANEF. Its neuroendocrine differentiation, potential to metastasize and somatostatin receptor type 2 expression prompt consideration and management of this disease as a neuroendocrine neoplasm. Learning points Our cases oppose the 2017 WHO classification of middle ear adenoma with neuroendocrine features as a benign disease. This entity warrants long-term follow-up, as local recurrence or persistence of disease is reported in up to 18% of surgically treated patients. PET/CT scan with 68Ga-labelled somatostatin analogues (SSA) can be used for staging of metastatic middle ear adenoma with neuroendocrine features. Unlabelled SSA and peptide receptor radionuclide therapy (PRRT) with radiolabelled SSA can be the first systemic therapeutic options for patients with advanced middle ear adenoma with neuroendocrine features.

Sign in / Sign up

Export Citation Format

Share Document