Risk of bowel ischemia in patients with mesenteric neuroendocrine tumors after treatment with 177Lu-DOTATATE

• Published in: Endocrine oncology Vol. 5; no. 1; p. e250033
• Main Authors: Pelle, Eleonora, Al-Toubah, Taymeyah, El-Haddad, Ghassan, Morse, Brian, Konda, Bhavana, Sukrithan, Vineeth, Strosberg, Jonathan
• Format: Journal Article
• Language: English
• Published: Bristol Bioscientifica Ltd 07.07.2025; Bioscientifica
• Subjects: bowel ischemia; Case Report; mesenteric lesions; prrt; small bowel net
• ISSN: 2634-4793; 2634-4793
• DOI: 10.1530/EO-25-0033

Lutetium-177 (177Lu)-DOTATATE is an effective treatment for metastatic gastroenteropancreatic (GEP) NETs. However, radiation can cause transient inflammation/swelling of tumors, which can result in toxicity. Treatment-related small bowel obstruction associated with mesenteric or peritoneal disease has been described. We investigated the potential for intestinal ischemia in 177Lu-DOTATATE-treated patients.BackgroundLutetium-177 (177Lu)-DOTATATE is an effective treatment for metastatic gastroenteropancreatic (GEP) NETs. However, radiation can cause transient inflammation/swelling of tumors, which can result in toxicity. Treatment-related small bowel obstruction associated with mesenteric or peritoneal disease has been described. We investigated the potential for intestinal ischemia in 177Lu-DOTATATE-treated patients.Clinical records were reviewed of patients with midgut NETs treated with 177Lu-DOTATATE at the Moffitt Cancer Center between April 2018 and December 2022 and at The Ohio State University between December 2017 and October 2020.MethodsClinical records were reviewed of patients with midgut NETs treated with 177Lu-DOTATATE at the Moffitt Cancer Center between April 2018 and December 2022 and at The Ohio State University between December 2017 and October 2020.Among the cases reviewed, we identified three patients who developed bowel ischemia/perforation shortly after their initial treatment with 177Lu-DOTATATE. All patients had metastatic small bowel NET with prominent mesenteric mass encasing/obstructing the mesenteric vessels and preexisting symptoms of postprandial abdominal pain.ResultsAmong the cases reviewed, we identified three patients who developed bowel ischemia/perforation shortly after their initial treatment with 177Lu-DOTATATE. All patients had metastatic small bowel NET with prominent mesenteric mass encasing/obstructing the mesenteric vessels and preexisting symptoms of postprandial abdominal pain.Acute bowel ischemia may be a rare complication of PRRT in patients with mesenteric arterial or venous obstruction from mesenteric metastasis.ConclusionAcute bowel ischemia may be a rare complication of PRRT in patients with mesenteric arterial or venous obstruction from mesenteric metastasis.