open access

Vol 59, No 4 (2008)
Case report
Published online: 2008-07-09
Submitted: 2013-02-15
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Multimodality palliative treatment of 111In-pentetreotide negative/123I-MIBG positive metastatic carcinoid - a case report

Dorota Dworakowska, Maria Gueorguiev, Ken Laji, Ashley B. Grossman
Endokrynologia Polska 2008;59(4):342-347.

open access

Vol 59, No 4 (2008)
Case report
Published online: 2008-07-09
Submitted: 2013-02-15

Abstract

Patients with carcinoid tumours frequently present with metastatic disease. There are only a few therapeutic options for these patients, and the main goal of palliative treatment is to reduce symptoms and thus to improve quality of life. Current therapy includes surgical resection, hepatic artery embolisation, chemotherapy and somatostatin analogue treatment; however, all these options have limitations. It seems probable that therapeutic modalities based on radiopharmaceuticals may provide better therapy, not only in relation to symptom reduction but may also improve patient survival.
In this case report we present a 46-year-old woman with a symptomatic carcinoid, who at the time of diagnosis had liver and abdominal lymph node metastases, the primary tumour being located in the terminal ileum. 111In-pentetreotide scanning was negative, whereas 123I-MIBG scanning showed high avidity in the tumour tissue. After right hemicolectomy, two courses of 131I-MIBG treatment were given (12.95 GBq and 12 GBq, respectively). After the second dose of 131I-MIBG temporary pancytopenia was present. Octreotide therapy was given empirically only for a short time and was stopped because of drug intolerance. The patient underwent tricuspid and pulmonary valve replacement because of her carcinoid heart disease, followed by two courses of embolisation of liver metastases. While 131I-MIBG therapy reduced the patient’s symptoms of flushing and diarrhoea, there has not yet been any effect on tumour response or 5-HIAA production. This case illustrates the multimodality and multidisciplinary approach to such patients.

Abstract

Patients with carcinoid tumours frequently present with metastatic disease. There are only a few therapeutic options for these patients, and the main goal of palliative treatment is to reduce symptoms and thus to improve quality of life. Current therapy includes surgical resection, hepatic artery embolisation, chemotherapy and somatostatin analogue treatment; however, all these options have limitations. It seems probable that therapeutic modalities based on radiopharmaceuticals may provide better therapy, not only in relation to symptom reduction but may also improve patient survival.
In this case report we present a 46-year-old woman with a symptomatic carcinoid, who at the time of diagnosis had liver and abdominal lymph node metastases, the primary tumour being located in the terminal ileum. 111In-pentetreotide scanning was negative, whereas 123I-MIBG scanning showed high avidity in the tumour tissue. After right hemicolectomy, two courses of 131I-MIBG treatment were given (12.95 GBq and 12 GBq, respectively). After the second dose of 131I-MIBG temporary pancytopenia was present. Octreotide therapy was given empirically only for a short time and was stopped because of drug intolerance. The patient underwent tricuspid and pulmonary valve replacement because of her carcinoid heart disease, followed by two courses of embolisation of liver metastases. While 131I-MIBG therapy reduced the patient’s symptoms of flushing and diarrhoea, there has not yet been any effect on tumour response or 5-HIAA production. This case illustrates the multimodality and multidisciplinary approach to such patients.
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Keywords

carcinoid; metastatic disease; paliative treatment

About this article
Title

Multimodality palliative treatment of 111In-pentetreotide negative/123I-MIBG positive metastatic carcinoid - a case report

Journal

Endokrynologia Polska

Issue

Vol 59, No 4 (2008)

Pages

342-347

Published online

2008-07-09

Bibliographic record

Endokrynologia Polska 2008;59(4):342-347.

Keywords

carcinoid
metastatic disease
paliative treatment

Authors

Dorota Dworakowska
Maria Gueorguiev
Ken Laji
Ashley B. Grossman

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