Case report of a patient with initially inoperable well-differentiated midgut neuroendocrine tumor (WDNT) — PRRT and long-acting somatostatin analogs as the neoadjuvant therapy
A 43-year-old man was admitted to Surgery Department becauseof abdominal pain, vomiting, weight loss and flushes. Computedtomography (CT) examination revealed upper and middle abdomentumor of about 110 × 110 mm. Histopathological analysis ofthe tissues obtained during the exploratory laparotomy confirmedWDNT (well-differentiated neuroendocrine tumor according tothe WHO classification 2000). The patient received 5 doses ofchemotherapy without any response. A positive result of 99mTc-[EDDA/Hynic] Octreotate scintigraphy (SRS) gave the possibility of PRRT (peptide receptor radionuclide therapy). The patientwas treated with the total dose of 400 mCi of 90Y-DOTA-TATE.CT performed after the PRRT revealed regression of the tumorsize to 72 × 94 mm. A decrease of CgA level and release ofsymptoms were also observed. Aiming at the removal of theconsiderable diminished tumor the patient was qualified for thesecond laparotomy. “Cytoreduction” surgery with partial excisionof the tumor was performed. Additionally tumor-affected appendixwas removed. The second focus of WDNT (according to the WHOclassification 2000) with Ki67 < 1% was found in the appendix. Pathologistsconfirmed the above-mentioned lesions as independent(an extremely rare clinical situation). The following treatment withlong-acting somatostatin analogs and 300 mCi of 90Y-DOTA-TATEresulted in further regression of the tumor size to 25 × 35 mm.Consecutive laparotomy is considered. If complete tumor removalmight be achieved is an open question. The above case reportshows the efficacy of combined therapy with the use of “hot” and“cold” somatostatin analogs not only in controlling the symptomsof the disease but also in obtaining tumor size regressionmaking surgical intervention possible. Such a neoadjuvant therapyseems to be a promising tool in the management of patients withinitially inoperable neuroendocrine tumors.A 43-year-old man was admitted to Surgery Department becauseof abdominal pain, vomiting, weight loss and flushes. Computedtomography (CT) examination revealed upper and middle abdomentumor of about 110 × 110 mm. Histopathological analysis ofthe tissues obtained during the exploratory laparotomy confirmedWDNT (well-differentiated neuroendocrine tumor according tothe WHO classification 2000). The patient received 5 doses ofchemotherapy without any response. A positive result of 99mTc-[EDDA/Hynic] Octreotate scintigraphy (SRS) gave the possibility of PRRT (peptide receptor radionuclide therapy). The patientwas treated with the total dose of 400 mCi of 90Y-DOTA-TATE.CT performed after the PRRT revealed regression of the tumorsize to 72 × 94 mm. A decrease of CgA level and release ofsymptoms were also observed. Aiming at the removal of theconsiderable diminished tumor the patient was qualified for thesecond laparotomy. “Cytoreduction” surgery with partial excisionof the tumor was performed. Additionally tumor-affected appendixwas removed. The second focus of WDNT (according to the WHOclassification 2000) with Ki67 < 1% was found in the appendix. Pathologistsconfirmed the above-mentioned lesions as independent(an extremely rare clinical situation). The following treatment withlong-acting somatostatin analogs and 300 mCi of 90Y-DOTA-TATEresulted in further regression of the tumor size to 25 × 35 mm.Consecutive laparotomy is considered. If complete tumor removalmight be achieved is an open question. The above case reportshows the efficacy of combined therapy with the use of “hot” and“cold” somatostatin analogs not only in controlling the symptomsof the disease but also in obtaining tumor size regressionmaking surgical intervention possible. Such a neoadjuvant therapyseems to be a promising tool in the management of patients withinitially inoperable neuroendocrine tumors
