Exceptional Therapeutic Outcome of Metastatic Neuroendocrine Tumor with Peptide Receptor Radionuclide Therapy with Brief Review of Literature

NETs are rare, heterogeneous group of neoplasm presented as chronic oncologic disease. Somatostatin analogue is the standard first line systemic therapy for mainly hormone control. No standard second line systemic treatment is available except everolimus which has no reported complete response. PRRT is an innovative molecular targeted treatment based on theragnostic concept for well differentiated NETs. We presented here a 63-year-old lady with grade 1 NET of rectum with lymphnodal and liver metastasis. She underwent sigmoid colostomy for bowel symptoms and started on sandostatin LAR. After progression, patient was treated with 4 cycles of 7.4GBq of 177Lu-DOTATATE at 10 weeks interval. No hematological and renal toxicity were noticed. Patient showed complete response in liver lesions & lymphnodes and partial response in rectal lesion on 68Ga-DOTANOC PET-CT. After multispecialty clinic board discussion, patient underwent curative surgery for residual rectal lesion and colostomy closer later on. Our case highlights a common presentation of NETs but an uncommon outcome with currently approved drugs. With this potential of disease cure in metastasis, PRRT may also be offered for locally advance disease as an adjuvant treatment for down staging.