Wheelchair-Bound Patient With Rare Metastatic Neck Tumor Has Exceptional Response to Peptide Radiation Therapy — Twice

A 45-year-old woman with metastatic carotid body tumor showed an excellent initial response to 177Lu-DOTATATE peptide receptor radionuclide therapy (PRRT). After disease progression with widespread metastases and spinal cord compression at multiple levels leaving her wheelchair-bound, rechallenge PRRT again produced an exceptional treatment response. This case demonstrates that retreatment with peptide-targeted radiation can be effective in somatostatin receptor-expressing paragangliomas.

This is a clinical case report of a single patient treated at a medical center. The patient was evaluated with imaging showing somatostatin receptor-expressing metastatic lesions, treated with 177Lu-DOTATATE PRRT initially with good response, then retreated upon disease recurrence. Treatment response was assessed clinically and with imaging.

Metastatic head and neck paragangliomas have very limited treatment options. This case demonstrates that peptide receptor radionuclide therapy — which specifically targets tumor cells using a somatostatin peptide analogue carrying a radioactive payload — can work not just once but twice in the same patient. This is important for clinicians managing these rare tumors who need to know that retreatment is a viable option.

Peptide receptor radionuclide therapy represents a precision medicine approach where peptides serve as targeting missiles to deliver radiation directly to tumor cells. This case adds to the growing evidence that PRRT retreatment is feasible and effective, particularly important for rare tumors where treatment evidence is limited. As PRRT is increasingly used for neuroendocrine tumors, understanding retreatment potential broadens its clinical utility.

This is a single case report, representing the lowest level of clinical evidence. Individual responses cannot be generalized to all patients with metastatic paragangliomas. Long-term outcomes, cumulative radiation safety, and specific imaging response details are not provided in the abstract. The rarity of metastatic carotid body tumors makes it difficult to study systematically.