Lutetium-177 DOTATATE for the Treatment of Esthesioneuroblastoma: A Case Report

Esthesioneuroblastoma (ENB), also known as olfactory neuroblastoma, is a rare neuroendocrine malignancy arising from the olfactory neuroepithelium. It exhibits a wide range of biological behaviors, from indolent to highly aggressive disease, often requiring a multimodal treatment approach involving surgical resection, radiotherapy, and chemotherapy, though outcomes remain variable. The overexpression of somatostatin receptors (SSTRs), particularly SSTR2, has led to the exploration of peptide receptor radionuclide therapy (PRRT) with lutetium-177 DOTATATE (Lu-177) as a targeted option in refractory cases. We present the case of a 64-year-old woman with recurrent, metastatic ENB, Kadish Stage D (T2N0M0G2). After undergoing surgical resection, intensity-modulated radiotherapy (IMRT), and systemic chemotherapy (cisplatin/etoposide), the patient experienced disease progression, prompting the initiation of targeted therapy with sunitinib. Given high SSTR expression detected on Gallium-68 PET imaging, four cycles of PRRT with Lu-177 DOTATATE were introduced with adverse effects (Grade 1 fatigue, nausea, leukopenia, anemia, and thrombocytopenia). While initial tumor regression was observed, subsequent progression necessitated further stereotactic body radiotherapy (SBRT) and temozolomide. This case highlights the therapeutic potential of PRRT with Lu-177 DOTATATE in treating refractory SSTR-expressing ENB. A multidisciplinary approach that integrates surgery, radiotherapy, systemic therapy, and theragnostic strategies remains essential to optimizing patient outcomes.