Endocrine Abstracts

Neuroendocrine tumors (NETs) represent the second most common malignancy of the small bowel (SB) and despite their indolent nature, NET liver metastasis (NETLMs) will develop in 50 to 60% of patients. Although there have been recent advances in the therapeutic armamentarium in patients with advanced NETs, surgical resection remains the only potentially curative intervention for patients with NETLMs. However, patients whose liver has been significantly invaded by the tumour (more than 50–70%) are very likely to have compromised liver remnant and suffer from postoperative liver failure, which makes them very poor candidates for operation. On the other hand, peptide receptor radionuclide therapy (PRRT) with 177 Lutetium-DOTATATE has gained substantial popularity and is typically employed in the management of grade I and grade II metastatic NETs. Hereby, we describe the case of a 69-year old woman diagnosed in March 2013 with ileum-cecal NET G2 (Ki67=5%), presenting at the Clinic of Endocrinology, UMP Iuliu-Hatieganu, Cluj-Napoca in 2016 with the clinical picture of liver metastasis and carcinoid syndrome, and later also of carcinoid heart disease. Her liver metastases were unresectable and there was no response in terms of clinical manifestations, NETs markers and tumor progression with high doses of somatostatin analogs (SSAs) therapy. Hence, a ⁶⁸Ga DOTANOC PET/CT was employed at Viena (AKH) in April 2017, which revelead the SSTR expression at the ileocecal valve, in the liver and in the bone as well. The patient underwent 4 cycles of PRRT with Lutetium 177- labeled DOTATATE in the same center. A significant clinical improvement as regard to the carcinoid syndrome was noted. Additionally, the response evaluation performed with ⁶⁸Ga-Dotanoc PET/CT in December 2017 revealed an improvement as well, with a reduction in the liver metastasis and a slightly lower tracer uptake on the mentioned areas (ileocecal valve, liver, bone). Therfore, PRRT may represent a promising therapeutical option in the care of patients with unresectable metastatic ileum-cecal NET, which can lengthen the time-to-progression and the time to health-related QoL deterioration, as well as increase survival probability.