Peptide Receptor Radionuclide Therapy in a Case of Multiple Spinal Canal and Cranial Paragangliomas

Multiple spinal and subtentorial intradural paragangliomas were detected in a surgically-treated cauda equina tumor, though it was not clear whether the masses were genuine metastases or an unknown “metachronous paraganglial syndrome”. Either way, the therapeutic options were few. Histology, immunohistochemistry, genetics and advanced molecular imaging were performed to further analyze the lesions and find an effective therapy. Given the high density of somatostatin receptors in the tumors, the patient underwent peptide receptor radionuclide therapy with [177Lu-DOTA0,Tyr3]-Octreotate. Follow-up MRI and 68Ga-DOTANOC PET/CT demonstrated very promising outcomes in terms of volume reduction (mean 69.9%±13%) and maximum standardized uptake value reduction (mean 84.8%±13.3%).