Endocrine Abstracts

During recent years, there has been some increase in the incidence of gastroenteropancreatic neuroendocrine tumours (GEP–NETs). In spite of noticeable advances in development of contemporary diagnostics and therapeutics, neuroendocrine tumours still present many clinical challenges to every-day clinical practice.

Therapeutic dilemmas will be presented as a case study including an example of a male patient JA, aged 68, diagnosed with hormone inactive pancreatic NET (NET G1) with metastases to the liver, bones and lymph nodes, who had undergone surgical removal of pancreatic cancer located in the body and tail of the pancreas, wedge resection of the right lobe of the liver, resection of the spleen (in 2000), chemotherapy and radio-frequency thermal ablation of liver metastasis. Slow progression of the volume of metastatic lesions in the liver and deterioration of clinical presentation was observed from 2004. PET/CT scans (⁶⁸Ga and ¹⁸FDG) made in 2010 confirmed neuroendocrine tumours had spread over the body and demonstrated the presence of somatostatin receptors within some areas of the liver, bones and lymph nodes. However, because of the increased FDG uptake within many metastatic lesions observed in ¹⁸FDG PET/CT, the patient was not eligible for systemic radioisotope therapy (PRRT). The patient received cold somatostatin analogues and radioembolisation of metastatic liver tumours (SIRT – intra-arterial administration of Y-90 DOTA-TATE), which led to a temporary stabilisation of symptoms. However, since further disease progression was noted, the therapy regimen was modified and supplemented with a targeted mTOR-inhibitor therapy, which improved clinical symptoms and caused partial regression of metastatic lesions in the liver and skeletal system recorded in the ⁶⁸Ga-DOTA-TATE PET/CT and ¹⁸FDG PET/CT check-up examinations.

Conclusions: Patients with GEP–NETs constitute a very differentiated group with diverse tumour biological behavior, which causes a variety of potential therapeutic problems. Therefore, these patients require personalised treatment modalities and, in particular, co-operation between interdisciplinary teams in making therapeutic decisions in order to achieve the best possible outcome.