Risk of Bowel Obstruction in Patients with Mesenteric or Peritoneal Disease Receiving Peptide Receptor Radionuclide Therapy

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FIGURE 1.
(A) Maximum-intensity projection demonstrates peritoneal carcinomatosis (arrow) and liver and mediastinal metastases in patient with progressive metastatic small-bowel NET. (B–D) Axial ⁶⁸Ga-DOTATATE PET (B), attenuation-correction CT (C), and ⁶⁸Ga-DOTATATE PET/CT (D) demonstrate uptake in extensive peritoneal metastatic implants (arrows).
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FIGURE 2.
Axial ⁶⁸Ga-DOTATATE PET (A), attenuation-correction CT (B), and ⁶⁸Ga-DOTATATE PET/CT (C) demonstrate somatostatin-receptor–expressive mesenteric (arrows) and peritoneal (arrowheads) metastases. There is mild tethering of loops of bowel to mesenteric mass in right lower quadrant (arrows).
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FIGURE 3.
Coronal contrast-enhanced CT of abdomen and pelvis demonstrates small-bowel obstruction with dilated loops of bowel tethered to mesenteric lesion (arrow).
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FIGURE 4.
Axial ⁶⁸Ga-DOTATATE PET (A), attenuation-correction CT (B), and ⁶⁸Ga-DOTATATE PET/CT (C) demonstrate somatostatin-receptor–expressive peritoneal carcinomatosis (arrows), including peritoneal lesions along anastomotic suture line (arrowheads).

TABLE 1

Patient Characteristics and Clinical Course

Patient no.	¹⁷⁷Lu-DOTATATE administration	Bowel-obstruction time point	Intervention	Outcome
1	Without steroids	1 wk after treatment 1	1: steroids	Treatment was discontinued; patient died 6 mo after treatment 1
		1 mo after treatment 1	2: surgical intervention, steroids
2	With steroids	2 wk after treatment 1	1: steroids	Patient remains on total parenteral nutrition
		3 wk after treatment 4	2: surgical intervention attempted (aborted); steroids
		3 mo after treatment 4	3: total parenteral nutrition
3	1 and 2: without steroids	5 wk after treatment 3	Steroids initially; major surgical abdominal debulking 5 mo after obstruction	Patient recovering from surgery and doing well
	3: with steroids
4	With steroids	3 mo after treatment 2	Treatment canceled; patient died 6 mo after treatment 2
		6 mo after treatment 2
5	Without steroids	10 d after treatment 2	Steroids	Patient recovered; future treatment delayed until further workup