Theranostics 2012; 2(5):459-471. doi:10.7150/thno.3594

Case Report

Lessons on Tumour Response: Imaging during Therapy with 177Lu-DOTA-octreotate. A Case Report on a Patient with a Large Volume of Poorly Differentiated Neuroendocrine Carcinoma

Ulrike Garske1✉, Mattias Sandström2, Silvia Johansson3, Dan Granberg4, Hans Lundqvist5, Mark Lubberink2, Anders Sundin6, Barbro Eriksson4

1. Nuclear medicine & PET, Uppsala University and Medical Sciences, Uppsala University Hospital, Uppsala, Sweden;
2. Nuclear medicine & PET, Uppsala University, Section of Medical Physics, Uppsala University Hospital, Uppsala, Sweden;
3. Department of Oncology, Radiology and Radiation Science, Section of Oncology and Nuclear Medicine, Uppsala University Hospital, Uppsala, Sweden;
4. Department of Medical Sciences, Section of Endocrine Oncology, Uppsala University Hospital, Uppsala, Sweden;
5. Uppsala University, Department of Oncology, Radiology and Radiation Science, Rudbeck Laboratory, Uppsala, Sweden;
6. Departments of Radiology, Karolinska Institute, Stockholm and Uppsala University Hospital, Sweden.

Abstract

Favourable outcomes of peptide receptor radiotherapy (PRRT) of neuroendocrine tumours have been reported during the last years. Still, there are uncertainties on the radionuclides to be used, the treatment planning, and the indication in patients with a high proliferation rate.

This case report describes a patient with a high tumour burden of poorly differentiated neuroendocrine carcinoma of unknown primary with a proliferation rate in liver metastases up to 50%, undergoing fractionated treatment with 7 cycles of 177Lu-DOTA-octreotate (7.4 GBq each) after disease progression on two different chemotherapy regiments. Based on initial staging scintigraphy, somatostatin receptor expression was very high.

Longitudinal dosimetry studies during therapy indicated ongoing increases in tumour-to-organ ratios that coincided with an objective response.

We conclude that fractionated therapy with 177Lu-DOTA-octreotate should be considered a treatment option also for those patients with large tumours, high proliferation, and high receptor expression.

Keywords: Neuroendocrine tumour, PRRT, 177Lu-DOTA-octreotate, radionuclide therapy, dosimetry.

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How to cite this article:
Garske U, Sandström M, Johansson S, Granberg D, Lundqvist H, Lubberink M, Sundin A, Eriksson B. Lessons on Tumour Response: Imaging during Therapy with 177Lu-DOTA-octreotate. A Case Report on a Patient with a Large Volume of Poorly Differentiated Neuroendocrine Carcinoma. Theranostics 2012; 2(5):459-471. doi:10.7150/thno.3594. Available from http://www.thno.org/v02p0459.htm