da Silva Tiago Nunes, van Velthuysen M L F, van Eijck Casper H J, Teunissen Jaap J, Hofland J, de Herder Wouter W
Department of Internal Medicine, ENETS Centre of Excellence, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands.
Department of Pathology, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands.
Endocrinol Diabetes Metab Case Rep. 2018 Apr 11;2018. doi: 10.1530/EDM-18-0015. eCollection 2018.
Non-functional pancreatic neuroendocrine tumours (NETs) can present with advanced local or distant (metastatic) disease limiting the possibility of surgical cure. Several treatment options have been used in experimental neoadjuvant settings to improve the outcomes in such cases. Peptide receptor radionuclide therapy (PPRT) using beta emitting radiolabelled somatostatin analogues has been used in progressive pancreatic NETs. We report a 55-year-old female patient with a 12.8 cm pancreatic NET with significant local stomach and superior mesenteric vein compression and liver metastases. The patient underwent treatment with [Lutetium-DOTATyr]octreotate (Lu-octreotate) for the treatment of local and metastatic symptomatic disease. Six months after 4 cycles of lutetium-octreotate, resolution of the abdominal complaints was associated with a significant reduction in tumour size and the tumour was rendered operable. Histology of the tumour showed a 90% necrotic tumour with abundant hyalinized fibrosis and haemorrhage compatible with PPRT-induced radiation effects on tumour cells. This report supports that PPRT has a role in unresectable and metastatic pancreatic NET.
PRRT with Lu-octreotate can be considered a useful therapy for symptomatic somatostatin receptor-positive pancreatic NET.The clinical benefits of PRRT with Lu-octreotate can be seen in the first months while tumour reduction can be seen up to a year after treatment.PRRT with Lu-octreotate was clinically well tolerated and did not interfere with the subsequent surgical procedure.PRRT with Lu-octreotate can result in significant tumour reduction and may improve surgical outcomes. As such, this therapy can be considered as a neoadjuvant therapy.
无功能性胰腺神经内分泌肿瘤（NETs）可表现为局部晚期或远处（转移）疾病，限制了手术治愈的可能性。在实验性新辅助治疗中已使用多种治疗选择来改善此类病例的治疗效果。使用发射β射线的放射性标记生长抑素类似物的肽受体放射性核素治疗（PPRT）已用于进展期胰腺NETs。我们报告了一名55岁女性患者，患有一个12.8厘米的胰腺NET，伴有明显的局部胃和肠系膜上静脉受压以及肝转移。该患者接受了[镥- DOTATyr]奥曲肽（镥-奥曲肽）治疗，以治疗局部和转移性症状性疾病。在4个周期的镥-奥曲肽治疗6个月后，腹部症状缓解，同时肿瘤大小显著减小，肿瘤变得可切除。肿瘤组织学显示90%的坏死肿瘤，伴有大量透明变性纤维化和出血，符合PPRT对肿瘤细胞的辐射效应。本报告支持PPRT在不可切除和转移性胰腺NET中具有作用。
用镥-奥曲肽进行PRRT可被认为是治疗有症状的生长抑素受体阳性胰腺NET的一种有用疗法。用镥-奥曲肽进行PRRT的临床益处可在最初几个月内显现，而肿瘤缩小可在治疗后长达一年时观察到。用镥-奥曲肽进行PRRT在临床上耐受性良好，且不干扰随后的手术程序。用镥-奥曲肽进行PRRT可导致肿瘤显著缩小，并可能改善手术效果。因此，这种疗法可被视为一种新辅助疗法。
