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. 2008 Apr;35(4):749-55.
doi: 10.1007/s00259-007-0691-z. Epub 2008 Jan 16.

Hormonal crises following receptor radionuclide therapy with the radiolabeled somatostatin analogue [177Lu-DOTA0,Tyr3]octreotate

Bart de Keizer  1 , Maarten O van Aken, Richard A Feelders, Wouter W de Herder, Boen L R Kam, Martijn van Essen, Eric P Krenning, Dik J Kwekkeboom
Affiliations

Hormonal crises following receptor radionuclide therapy with the radiolabeled somatostatin analogue [177Lu-DOTA0,Tyr3]octreotate

Bart de Keizer et al. Eur J Nucl Med Mol Imaging. 2008 Apr.

Abstract

Introduction: Receptor radionuclide therapy is a promising treatment modality for patients with neuroendocrine tumors for whom alternative treatments are limited. The aim of this study was to investigate the incidence of hormonal crises after therapy with the radiolabeled somatostatin analogue [(177)Lu-DOTA(0),Tyr(3)]octreotate ((177)Lu-octreotate).

Materials and methods: All (177)Lu-octreotate treatments between January 2000 and January 2007 were investigated. Four hundred seventy-six patients with gastroenteropancreatic neuroendocrine tumors and three patients with metastatic pheochromocytoma were included for analysis.

Results: Four hundred seventy-nine patients received a total of 1,693 administrations of (177)Lu-octreotate. Six of 479 patients (1%) developed severe symptoms because of massive release of bioactive substances after the first cycle of (177)Lu-octreotate. One patient had a metastatic hormone-producing small intestinal carcinoid; two patients had metastatic, hormone-producing bronchial carcinoids; two patients had vasoactive intestinal polypeptide-producing pancreatic endocrine tumors (VIPomas); and one patient had a metastatic pheochromocytoma. With adequate treatment, all patients eventually recovered.

Conclusion: Hormonal crises after (177)Lu-octreotate therapy occur in 1% of patients. Generally, (177)Lu-octreotate therapy is well tolerated.

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Figures

Fig. 1
Fig. 1
Post-therapy scintigrams after 177Lu-octreotate of patient 1 (a), patient 2 (b), patient 3 (c), patient 4 (d), patient 5 (e), and patient 6 (f). Upper row Anterior images of the thorax, middle row anterior images of the abdomen, and lower row anterior images of the pelvic region. Note that the focal increased 177Lu-octreotate accumulations in liver metastases in all patients and focal uptake in bone metastases in patients 1, 2, and 4. In patient 6, there was also uptake in multiple lung metastases
Fig. 2
Fig. 2
Normetanephrines in 24 h urine (μmol) of patient 6 after 177Lu-octreotate treatment. Note the excessive release of normetanephrines after the first cycle of 177Lu-octreotate. Normal value urinary normetanephrines: <5.1 μmol/24 h
See this image and copyright information in PMC

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