Effective treatment of bone metastases from a neuroendocrine tumour of the pancreas with high activities of Indium-111-pentetreotide

Department of Nuclear Medicine, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands. m.p.m.stokkel@lumc.nl

OBJECTIVE: To evaluate therapy with high doses of (111)Indium pentetreotide in a patient with bone metastases from a carcinoid of the pancreas. CASE REPORT: A 55-Year-old male presented in November 1990 with stomach ache with dorsal irradiation. Ultrasonography and computed tomography (CT-) scans of the abdomen revealed a tumour of the tail of the pancreas and liver metastases. Histological examination revealed a neuroendocrine tumour. Surgery and polychemotherapy were initiated and after seven cycles a tumour regression of 30% was achieved. During follow-up multiple metastases were seen upon bone scintigraphy for which treatment with high doses Indium-111-octreotide was initiated. MATERIALS AND METHODS: The patient underwent eight cycles, with one cycle every 5 weeks. Each treatment consisted of an i.v. injection of 6 GBq Indium-111-pentetreotide. Comparing the results of the first and the last post-treatment scintigraphy, a regression of the number and intensity of uptake in the lesions was found. Bone scintigraphy showed a regression of the skeletal lesions as well, while X-ray, CT-scan and chromogranin-A levels showed stable disease. CONCLUSION: Results from the treatment of our patient indicate that the use of high dose radiolabelled somatostatin analogues could be of significant use, even in the case of bone metastases. To our knowledge, this is the first report describing therapeutic effects on bone metastases from a neuroendocrine tumour.