Di Franco Martina, Durmo Rexhep, Di Paolo Maria Liberata, Giacosa Roberto, Bannò Elisa, Ambrosini Valentina, Filice Angelina
Nuclear Medicine, Alma Mater Studiorum, University of Bologna, Bologna, Italy.
Nuclear Medicine Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy.
Front Oncol. 2025 May 19;15:1590478. doi: 10.3389/fonc.2025.1590478. eCollection 2025.
Zollinger-Ellison Syndrome (ZES) is a rare condition characterized by excessive gastric acid secretion due to gastrin-producing neuroendocrine tumors. Peptide Receptor Radionuclide Therapy (PRRT) with [177Lu]Lutetium Oxodotreotide is an effective treatment for advanced neuroendocrine tumors, including those associated with ZES. However, the gastrointestinal toxicity induced by ZES can complicate the administration of PRRT. We present a case of a patient with metastatic G2 neuroendocrine tumor of the duodenum and ampulla of Vater who experienced severe gastrointestinal complications after the first PRRT cycle due to exacerbated ZES. The implementation of a prophylactic treatment with high-dose proton pump inhibitors before and after the subsequent PRRT cycles allowed for the successful completion of the therapy. This case highlights the importance of considering ZES-related complications in patients undergoing PRRT. Proactive management with high dose acid-suppressing therapy can significantly improve patient tolerance and treatment outcomes. Further research is needed to optimize the management of ZES patients undergoing PRRT.
卓-艾综合征（ZES）是一种罕见疾病，其特征为因产生胃泌素的神经内分泌肿瘤导致胃酸分泌过多。使用[177Lu]镥奥曲肽进行肽受体放射性核素治疗（PRRT）是治疗晚期神经内分泌肿瘤（包括与ZES相关的肿瘤）的有效方法。然而，ZES引起的胃肠道毒性会使PRRT的给药变得复杂。我们报告一例十二指肠和 Vater 壶腹转移性 G2 神经内分泌肿瘤患者，由于 ZES 加重，在首个 PRRT 周期后出现严重胃肠道并发症。在后续 PRRT 周期前后使用高剂量质子泵抑制剂进行预防性治疗，使治疗得以成功完成。该病例突出了在接受 PRRT 的患者中考虑与 ZES 相关并发症的重要性。采用高剂量抑酸疗法进行积极管理可显著提高患者耐受性和治疗效果。需要进一步研究以优化接受 PRRT 的 ZES 患者的管理。
