Nucl Med Mol Imaging.  2015 Sep;49(3):223-230. 10.1007/s13139-015-0332-6.

The Challenges of Treating Paraganglioma Patients with 177Lu-DOTATATE PRRT: Catecholamine Crises, Tumor Lysis Syndrome and the Need for Modification of Treatment Protocols

• Makis W
• McCann K
• McEwan AJ

• KMID: 2052057
• DOI: http://doi.org/10.1007/s13139-015-0332-6

Abstract

PURPOSE
A high percentage of paragangliomas express somatostatin receptors that can be utilized for targeted radioisotope therapy. The aim of this study was to describe and discuss the challenges of treating these tumors with 177Lu-[DOTA0,Tyr3]octreotate (DOTATATE) radioisotope therapy using established protocols.
METHODS AND RESULTS
Three paraganglioma patients were treated with 4-5 cycles of 177Lu-DOTATATE and were evaluated for side effects and response to therapy. Two of the three patients developed severe adverse reactions following their first 177Lu-DOTATATE treatment. One patient developed a catecholamine crisis and tumor lysis syndrome within hours of treatment, requiring intensive care unit (ICU) support, and another developed a catecholamine crisis 3 days after treatment, requiring hospitalization. The treatment protocols at our institution were subsequently modified by increasing the radioisotope infusion time from 15 to 30 min, as recommended in the literature, to 2-4 h and by reducing the administered dose of 177Lu-DOTATATE. Subsequent 177Lu-DOTATATE treatments utilizing the modified protocols were well tolerated, and response to therapy was achieved in all three patients, resulting in significantly improved quality of life.
CONCLUSION
177Lu-DOTATATE is an exciting new therapeutic option in the management of paragangliomas; however, current treatment protocols described in the literature may need to be modified by lengthening the infusion time and/or lowering the initial treatment dose to prevent or reduce the severity of adverse reactions.

Keyword

177Lu-DOTATATE; PRRT; Radioiosotope therapy; Paraganglioma; Catecholamine crisis; Tumor lysis syndrome; Neuroendocrine tumor

MeSH Terms

Clinical Protocols*
Hospitalization
Humans
Intensive Care Units
Neuroendocrine Tumors
Paraganglioma*
Quality of Life
Receptors, Somatostatin
Tumor Lysis Syndrome*
Receptors, Somatostatin