Sowa-Staszczak Anna, Pach Dorota, Stefańska Agnieszka, Szybiński Piotr, Kulig Jan, Tomaszewska Romana, Chrzan Robert, Hubalewska-Dydejczyk Alicja
Department of Endocrinology, Jagiellonian University, Medical College, Krakow, Poland.
Nucl Med Rev Cent East Eur. 2012 Aug 26;15(2):137-9.
A 43-year-old man was admitted to Surgery Department because of abdominal pain, vomiting, weight loss and flushes. Computed tomography (CT) examination revealed upper and middle abdomen tumor of about 110 × 110 mm. Histopathological analysis of the tissues obtained during the exploratory laparotomy confirmed WDNT (well-differentiated neuroendocrine tumor according to the WHO classification 2000). The patient received 5 doses of chemotherapy without any response. A positive result of 99mTc-[EDDA/Hynic] Octreotate scintigraphy (SRS) gave the possibility of PRRT (peptide receptor radionuclide therapy). The patient was treated with the total dose of 400 mCi of 90Y-DOTA-TATE. CT performed after the PRRT revealed regression of the tumor size to 72 × 94 mm. A decrease of CgA level and release of symptoms were also observed. Aiming at the removal of the considerable diminished tumor the patient was qualified for the second laparotomy. "Cytoreduction" surgery with partial excision of the tumor was performed. Additionally tumor-affected appendix was removed. The second focus of WDNT (according to the WHO classification 2000) with Ki67 < 1% was found in the appendix. Pathologists confirmed the above-mentioned lesions as independent (an extremely rare clinical situation). The following treatment with long-acting somatostatin analogs and 300 mCi of 90Y-DOTA-TATE resulted in further regression of the tumor size to 25 × 35 mm. Consecutive laparotomy is considered. If complete tumor removal might be achieved is an open question. The above case report shows the efficacy of combined therapy with the use of "hot" and "cold" somatostatin analogs not only in controlling the symptoms of the disease but also in obtaining tumor size regression making surgical intervention possible. Such a neoadjuvant therapy seems to be a promising tool in the management of patients with initially inoperable neuroendocrine tumors.
一名43岁男性因腹痛、呕吐、体重减轻和潮热入住外科。计算机断层扫描（CT）检查显示中上腹有一个约110×110毫米的肿瘤。剖腹探查术中获取组织的组织病理学分析证实为WDNT（根据2000年世界卫生组织分类为高分化神经内分泌肿瘤）。该患者接受了5次化疗但无任何反应。99mTc-[EDDA/Hynic]奥曲肽闪烁扫描（SRS）结果呈阳性，提示有可能进行肽受体放射性核素治疗（PRRT）。该患者接受了总剂量为400mCi的90Y-DOTA-TATE治疗。PRRT后进行的CT显示肿瘤大小缩小至72×94毫米。同时观察到嗜铬粒蛋白A（CgA）水平降低以及症状缓解。为切除明显缩小的肿瘤，该患者符合进行第二次剖腹手术的条件。实施了肿瘤部分切除的“减瘤”手术。此外，切除了受肿瘤影响的阑尾。在阑尾中发现了第二个WDNT病灶（根据2000年世界卫生组织分类），Ki67<1%。病理学家证实上述病变为独立存在（这是一种极其罕见的临床情况）。随后使用长效生长抑素类似物和300mCi的90Y-DOTA-TATE进行治疗，导致肿瘤大小进一步缩小至25×35毫米。正在考虑进行后续剖腹手术。能否实现肿瘤完全切除仍是一个悬而未决的问题。上述病例报告显示，联合使用“热”和“冷”生长抑素类似物进行治疗不仅能控制疾病症状，还能使肿瘤大小缩小，从而使手术干预成为可能。这种新辅助治疗似乎是管理初始无法手术的神经内分泌肿瘤患者的一种有前景的工具。
