Carcinoid crisis induced by receptor radionuclide therapy with 90Y-DOTATOC in a case of liver metastases from bronchial neuroendocrine tumor (atypical carcinoid)

Abstract

SS receptors are overexpressed in many tumors, mainly of neuroendocrine origin, thus enabling the treatment with SS analogs. The clinical experience of receptor radionuclide therapy with the new analog [90Y-DOTA0-Tyr3 ]-octreotide [90Y-DOTATOC] has been developed over the last decade and is gaining a pivotal role in the therapeutic workout of these tumors. It is well known that some procedures performed in diagnostic and therapeutic management of endocrine tumors, such as agobiopsy and hepatic chemoembolization, can be associated with the occurrence of symptoms related to the release of vasoactive amines and/or hormonal peptides from tumor cell lysis. This is the first report of a severe carcinoid crisis developed after receptor radionuclide therapy with 90Y-DOTATOC administered in a patient affected by liver metastases from bronchial neuroendocrine tumor (atypical carcinoid). Despite protection with H1 receptor antagonists, octreotide and corticosteroids, few days after the therapy the patient complained of persistent flushing of the face and upper trunk, severe labial and periocular oedema, diarrhoea and loss of appetite. These symptoms increased and required new hospitalisation. The patient received iv infusion of octreotide associated with H1 and H2 receptor antagonists and corticosteroid therapy, which induced symptom remission within few days. The case here reported confirms that radionuclide therapy is highly effective in determining early rupture of metastatic tissue and also suggests that pre-medication should be implemented before the radiopeptide administration associated with a close monitoring of the patient in the following days.

Yttrium-labelled peptides for therapy of NET

“…This appears to be related to the massive cell lysis and hormonal stimulation occurring after PRRT, which must be prevented and treated accordingly [36,37].…”

Somatostatin Analogues Do Not Prevent Carcinoid Crisis

“…(Ahlman et al, 1987;Marsh et al, 1987;Roy et al, 1987;Ahlman et al, 1988a;Ockert and White, 1988;Darby et al, 1990;Debas and Mulvihill, 1994;Deguchi et al, 1994;Parry et al, 1996;Pekarek et al, 1997;Balestrero et al, 2000;Janssen et al, 2000;Kharrat and Taubin, 2003;Zimmer et al, 2003;Koopmans et al, 2005;Davi et al, 2006;Majeed et al, 2007;Papadogias et al, 2007;De Keizer et al, 2008;McPherson et al, 2009;Sinha et al, 2009;Yazbek-Karam et al, 2009;Fujie et al, 2010;Morrisroe et al, 2012;Raikhelkar et al, 2012;Shah et al, 2012;Massimino et al, 2013;van Diepen et al, 2013) The prophylactic usage of SSTA was diverse between different studies varying from long acting SSTA to continuous somatostatin infusion. Of the 28 patients with known demographic information, 17 cases (60.7%) were men and 11 cases (39.3%) were women.…”

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

“…The carcinoid syndrome in patients with metastatic bronchial carcinoids is mediated by 5-hydroxytryptophan, its conversion to serotonin and/or by histamine[12]. The only other documented carcinoid crisis after radionuclide receptor therapy also involved a patient with a bronchial carcinoid [7]. Only one of the 241 patients with a carcinoid originating from the digestive tract had a hormonal crisis.…”

“…The symptomatology involves profound flushing, hypotension, or extreme changes in blood pressure, diarrhea, bronchoconstriction, and arrhythmias [6]. So far, only one case of a carcinoid crisis after therapy with a radiolabeled somatostatin analogue has been described [7]. Another well-recognized endocrine emergency can occur in patients with pheochromocytomas.…”