Imaging-Guided Use of Combined ¹⁷⁷Lu-DOTATATE and Capecitabine Therapy in Metastatic Mediastinal Paraganglioma

(A) Baseline ¹⁸F-FDG PET/CT maximum-intensity-projection and transaxial fused images showed intensely tracer-avid (SUV_max, 40) right inferior mediastinal mass (∼8.0 × 5.2 × 9.4 cm), left iliac mass (SUV_max, 47.6), and widespread skeletal lesions. (B) Baseline ⁶⁸Ga-DOTANOC PET/CT showed intensely tracer-avid posterior mediastinal mass (SUV_max, 88) and multiple lytic skeletal lesions (left iliac bone SUV_max, 49.5). (C) Interim ⁶⁸Ga-DOTANOC PET/CT showed significant decrease in tracer avidity within lesions (SUV_max, 88–16.4 in mediastinal mass and 49.5–20.1 in left iliac bone/soft-tissue lesion) and concurrent decrease in size of lesions. (D) ⁶⁸Ga-DOTANOC PET/CT 2 mo after fourth cycle of peptide receptor chemoradionuclide therapy revealed disease progression.