Introduction
Materials and methods
Patients
Methods
Results
Patient characteristics
Tumor type | Number of patients | Somatostatin analogue pretreatment | Liver metastases | Bone metastases | CgA (µg/l) median (range) | Relevant laboratory findings median (range) |
---|---|---|---|---|---|---|
Carcinoids
| ||||||
-Digestive tract carcinoid | 241 | 142 | 223 | 57 | 537 (22-787,742) | Urinary 5HIAA (μmol/24 h) 222 (7-2,048) |
-Bronchial carcinoid | 20 | 7 | 16 | 13 | 1,252 (35-900,280) | Urinary 5HIAA (µmol/24 h) 191 (15-1,440) |
-Thymic carcinoid | 4 | 0 | 1 | 1 | 294 (147-725) | - |
Functioning PNETs
| ||||||
-VIPoma | 3 | 0 | 3 | 9 | 153 (22-318) | VIP (pg/ml) 470 (144-710) |
-Insulinoma | 11 | 3 | 8 | 4 | 1256 (69-21,509) | - |
-Gastrinoma | 21 | 8 | 19 | 5 | 2,282 (111-55,715) | Gastrin (μg/l) 1.2 (0.03-22) |
Non functioning PNETs
| 124 | 25 | 107 | 24 | 385 (26-162,710) | - |
Neuroendocrine tumour of unknown origin
| 52 | 10 | 44 | 18 | 400 (23-29,110) | - |
metastatic pheochromocytoma
| 3 | 1 | 1 | 2 | 5,666 (928-6,900) | - |
Total | 479 | 200 (42%) | 422 (88%) | 124 (26%) |
Therapy and complications
Case | Age/Sex | Tumor | Years since diagnosis | Treatment before 177Lu-octreotate | Clinical symptoms before 177Lu-octreotate | Relevant laboratory findings before 177Lu-octreotate | Continuation of somatostatin analogues prior to 177Lu-octreotate | Onset of “crisis” in relation to administration of 177Lu-octreotate | Predominant symptomatology | Treatment of “crisis” | Duration of hospitalization | Disease course |
---|---|---|---|---|---|---|---|---|---|---|---|---|
1 | 65/M | Bronchial carcinoid with mediastinal lymph node, liver and bone metastases | 4 | External radiation therapy, octreotide LAR | Flushing and diarrhea, several carcinoid crises requiring hospitalization | CgA 4,379 μg/l, urinary 5HIAA 399 μmol/24 h | No | Immediately | Nausea, worsening of diarrhea, severe flushing | Fluids i.v., octreotide, corticosteroids, metoclopramide, loperamide | 5 days | 2 more cycles of 177Lu-octreotate treatment without discontinuation of octreotide treatment. Both again leading to hormonal release requiring hospitalization. Died after 1 year because of progressive disease |
2 | 62/F | Bronchial carcinoid with liver and bone metastases | 11 | Lobectomy left upper lobe, external radiation therapy, intrabronchial laser coagulation of tumor, octreotide LAR, interferon-alpha | Flushing and diarrhea, carcinoid crisis after intrabronchial laser coagulation of tumor | CgA 110,000 μg/l 978 μmol/24 h | No | After 2 days | Severe flushing, worsening of diarrhea, dehydration | Fluids i.v., corticosteroids, octreotide | 11 days | 3 more cycles of 177Lu-octreotate, with discontinuation of octreotide treatment without serious side effects. Died after 1 year because of progressive disease |
3 | 53/F | VIPoma with liver metastases | 1 | Distal pancreatectomy, radiofrequency ablation of liver metastases, cisplatin, etoposide, octreotide LAR | Severe diarrhea, hypokalemia and dehydration | VIP 470 pg/ml CgA 318 μg/l | No | After 2 days | Nausea, severe diarrhea, metabolic acidosis, hypokalemia dehydration | Fluids i.v., potassium, metoclopramide, octreotide | 4 days | 3 more cycles of 177Lu-octreotate, with discontinuation of octreotide treatment 1 year later improvement of general condition, less diarrhea and less flushing |
4 | 44/F | VIPoma with liver and bone metastases | 2 | Streptozine, 5-fluoracil and adriamycine, embolization of liver metastases, lanreotide octreotide, loperamid, potassium | Flushing and diarrhea hypokalemia and dehydration | VIP 710 pg/ml CgA 335 μg/l | Yes | Immediately | Severe diarrhea, metabolic acidosis, hypokalemia, dehydration | Fluids i.v., potassium, octreotide, loperamide, metoclopramide | 13 days | 2 more cycles of 177Lu-octreotate, with continuation of octreotide and corticosteroids. After the second cycle again hormonal crisis requiring hospitalization. Died after 1 year because of progressive disease |
5 | 50/M | Small intestinal carcinoid with liver metastases | 15 | Debulking surgery, interferon-alpha, 5-fluorouracil and leucovorin, octreotide LAR | Flushing and diarrhea | CgA 2950 μg/l, urinary 5HIAA 902 μmol/24 h | Yes | Immediately | Nausea, vomiting, flushing, hypotension | Fluids i.v., octreotide, metoclopramide | 6 days | 6 more cycles of 177Lu-octreotate (half dose, 3,700 MBq) without discontinuation of octreotide. After second cycle, again hormonal crisis requiring hospitalization. Still alive after 2 years, still episodic diarrhea |
6 | 63/M | Malignant pheochromocytoma with lung bone abdominal lymphnode and liver metastases | 2 | Adrenalectomy, alpha- and beta-adrenergic blockade, octreotide | Nausea | Urinary normetanephrines 79 μmol/24 h, urinary metanephrines 10 μmol/24 h; CgA 6,900 μg/l | No | After 1 day | Hypotension, extensive sweating, cardiac ischemia | Fentolamine, octreotide, bisoprolol, morfine | 2 months | 3 more cycles 177Lu-octreotate without side effects (with continuation of octreotide and corticosteroids). Died after 1 1/2 years because of progressive disease |