RADIOTHERAPY FOR SUBCUTANEOUS METASTASES FROM PANCREATIC NEUROENDOCRINE TUMOR: A CASE REPORT

RADIOTHERAPY FOR SUBCUTANEOUS METASTASES FROM PANCREATIC NEUROENDOCRINE TUMOR: A CASE REPORT rare and the optimal palliative approach is uncertain. Systemic therapies and supportive cares are administered in the majority of cases. In this report we describe our experience in the multidisciplinary management of a case of pancreatic neuroendocrine tumor with multiple subcutaneous metastases, highlighting the advantages achieved with palliative radiotherapy delivered to symptomatic skin metastases. Methods: A 61-year-old woman affected by a pancreatic small cell neuroendocrine carcinoma with multiple hepatic and subcutaneous metastases was referred to our Radiation Oncology Unit after a multidisciplinary evaluation. Indeed, the patient had obtained an initial partial response of her visceral lesions with chemotherapy (Cisplatin- and Etoposide-based), but a progression of subcutaneous metastases was detected. Two different RT treatments were planned and delivered for a skin mass at the right fronto-temporal region of the scalp and for two lesions at the right scapular region and at the back of the left thoracic wall, respectively. All lesions were large (at least 10 centimeters in diameter) and easily bleeding.A total dose of 30 Gy in 10 fractions was prescribed for the scalp lesion, while a total dose of 20 Gy in 5 fraction was delivered to each back lesions, simultaneously. Both the radiation treatments were planned with 6-MV non-coplanar photon beams tangent to the skin, ensuring a useful dose-sparing of normal tissues. Second-line chemotherapy schemes were administered but soon discontinued due to hematological toxicity (especially thrombocytopenia). Results: The treated lesions stopped bleeding and showed a progressive shrinkage. The skin became progressively crusted and remained stationary until patient’s death. The patient did not show treatment-rela ted side effects and experienced a sensitive improvement of her quality of life. During chemotherapy administration, an overall diffuse reduction of skin lesions was also observed. Unfortunately, the patient died about two months after completion of RT due to cachexia. Conclusions: Palliative radiotherapy delivered to symptomatic skin metastases from neuroendocrine tumors could allow a satisfactory local response, as well as an improvement of patient’s quality of life. For these reasons, this approach could be considered for selected patients and should be re-evaluated in the multidisciplinary management of these rare tumors with poor prognosis.