RT Journal Article SR Electronic T1 Imaging-Guided Use of Combined 177Lu-DOTATATE and Capecitabine Therapy in Metastatic Mediastinal Paraganglioma JF Journal of Nuclear Medicine Technology JO J. Nucl. Med. Technol. FD Society of Nuclear Medicine SP 314 OP 316 DO 10.2967/jnmt.117.197400 VO 45 IS 4 A1 Abhiram G. Ashwathanarayana A1 Chinmoy K. Biswal A1 Ashwani Sood A1 Ashwin S. Parihar A1 Rakesh Kapoor A1 Bhagwant R. Mittal YR 2017 UL http://tech.snmjournals.org/content/45/4/314.abstract AB Peptide receptor radionuclide therapy targets highly expressed somatostatin receptors in well-differentiated neuroendocrine tumors, producing stability or a partial response in most patients with inoperable or metastatic disease. However, neuroendocrine tumors showing increased 18F-FDG uptake have limited treatment options and a poor outcome, and the role of peptide receptor radionuclide therapy is still unclear. Here, we present the case of a young man with mediastinal paraganglioma and extensive metastatic disease showing avidity on both somatostatin receptor imaging and 18F-FDG imaging. The patient experienced a partial response to peptide receptor chemoradionuclide therapy (177Lu-DOTATATE and low-dose capecitabine), as well as a significantly improved quality of life. This case highlights the utility of peptide receptor chemoradionuclide therapy when there is extensive disease avid for both somatostatin receptor and 18F-FDG and a lack of other suitable treatment modalities.