Hepatopulmonary Shunt Reduction With 177Lu-DOTATATE Therapy

Area of Science:

• Nuclear Medicine
• Oncology
• Radiology

Background:

• Neuroendocrine tumors (NETs) can metastasize to the liver.
• Gallium-68 DOTATATE Positron Emission Tomography/Computed Tomography (Ga-DOTATATE PET/CT) is crucial for detecting NETs.
• Hepatic radioembolization is a treatment option for liver metastases, but requires a low hepatopulmonary shunt fraction.

Observation:

• A 72-year-old man presented with well-differentiated NET of unknown primary with liver metastases.
• Liver lesions were only visible on Ga-DOTATATE PET/CT, not Fluorine-18 Fluorodeoxyglucose PET/CT (F-FDG PET/CT).
• The patient had a hepatopulmonary shunt fraction of 31.6%, precluding radioembolization.

Findings:

• Lutetium-177 DOTATATE (Lu-DOTATATE) therapy was administered due to the contraindication for radioembolization.
• The patient received 4 courses of Lu-DOTATATE therapy.
• Post-treatment Ga-DOTATATE PET/CT revealed regression of liver lesions.
• The hepatopulmonary shunt fraction decreased to 8% after Lu-DOTATATE therapy.

Implications:

• Lu-DOTATATE therapy is a viable alternative for NET liver metastases when radioembolization is contraindicated.
• Successful Lu-DOTATATE treatment can reduce hepatopulmonary shunt fraction, potentially enabling future radioembolization.
• This case highlights the importance of personalized treatment strategies in metastatic NET management.