Multidisciplinary Management of Metastatic Pancreatic Neuroendocrine Tumor Using a Combination of Beta, Alpha Radionuclide and Ethanol Ablation Therapies.

Peptide receptor radionuclide therapy (PRRT) using beta ( 177 Lu-DOTATATE) and alpha ( 225 Ac-DOTATATE) therapy seems to be a safe and effective treatment option for advanced gastroenteropancreatic (GEP) neuroendocrine tumors (NETs). However, treatment efficacy needs to be balanced with long-term outcomes and adverse events, especially in young patients with a longer life expectancy. Local therapy may be a more effective and safe option in achieving a cure in such cases. The index case shows the efficacy of endoscopic ultrasound (EUS)-guided ethanol ablation of residual metastatic lymph nodes in achieving a complete response after beta followed by alpha PRRT in a young patient.