My question would be: why unreachable by surgery? Bone metastases?

Thank you Jasna. Martin I sent you an email.. 

Beside that he is MIBG negative. somebody has experience with the use of Somatostain analogues in these kind of patients?

Dear Nelson,

why does the surgery could not be performed? are there multiple mets?

regarding SSA treatment. If the tumor expresses the somatostatin receptors it can be applied.

we have one young patient receiveing somatostatin and he has a stable disease during the last two years.

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attila 

Thank you Attila, the lesions are sticked to diaphragm muscle, cava vein, kidney and other tissues. We wiññ try with Lutetium dotatate because the tumor express high SUV in the Galium dotatate, but for know I am glad to hear from you that you have had good results with SRL. Thanks again. 

Dear Dr Nelson

if surgeon cannot remove the tissue that hi suv in PET,Lutetium-177]-DOTA-octreotate or everolimus is useful.

we have fair experience with everolimus.

Thank you Dr Mahmoodzadeh, we will start with 177Lu cicles and then SLR like Somatulin 90 mg every 28 days. 

Are all lesions GaTate avid? In my centre, we perform MIBG, GaTate and FDG to characterise all tumoural lesions. Most patient has heterogenous uptake in all 3 modalities.  LuTate has good tumoural control only on high GaTate avid lesion. May need other approach in nonGaTate avid lesion. We have a patient with GaTate avid large pheo with bone mets, which is surgically inoperable. After 4 cycles, her hypertesion improved and bony pain resolved. She was able to walk again and put on weight. Scintigraphically, the lesions still present

Thank kou Teik Hin Tan. The lesions were Ga TATE intensively avid and MIBG was negative.