Image guided combination of ¹⁷⁷Lu-DOTATATE and capecitabine peptide receptor chemoradionuclide therapy in metastatic mediastinal paraganglioma

Abstract

The peptide receptor radionuclide therapy (PRRT) targets highly expressed somatostatin receptors (SSTR) shown on SSTR imaging in well-differentiated neuroendocrine tumours (NETs) with stable or partial response in majority of inoperable/metastatic NETs patients. However NETs showing increased FDG uptake carry the poor outcome with limited treatment options and role of PRRT is still unclear. Here is a case of young male patient of mediastinal paraganglioma and extensive metastatic disease showing avidity both on SSTR and FDG imaging. The patient showed partial response and significant improvement in quality of life with peptide receptor chemo-radionuclide therapy (PRCRT) in the form of ¹⁷⁷Lu-DOTATATE along with low dose capecitabine. This case highlights the utility of PRCRT in extensive disease with SSTR and FDG avidity where other treatment modalities may not be suitable.