Highly Symptomatic Progressing Cardiac Paraganglioma With Intracardiac Extension Treated With (177)Lu-DOTATATE: A Case Report

INTRODUCTION: Primary cardiac paragangliomas are rare tumors. Metastatic disease is even rarer. Surgical management is technically challenging, and sometimes even impossible. Available therapeutic modalities for metastatic disease include external beam radiation therapy as well as systemic treatments, namely (131)I-MIBG and more recently, peptide receptor radionuclide therapy (PRRT) with (177)Lu-DOTATATE. To our knowledge, this is the first case of progressive unresectable cardiac paraganglioma with intracardiac extension treated with dosimetry based personalized PRRT to be reported. This case is of particular interest since it documents for the first time the efficacy, and especially the safety of the (177)Lu-DOTATATE PRRT in this precarious context for which therapeutic options are limited. CASE PRESENTATION: A 47-year-old man with no medical history consulted for rapidly decreasing exercise tolerance. The investigation demonstrated an unresectable progressing metastatic cardiac paraganglioma with intracardiac extension. The patient was treated with personalized (177)Lu-DOTATATE PRRT and showed complete symptomatic and partial anatomical responses, with a progression-free survival of 13 months. CONCLUSIONS: PRRT with (177)Lu-DOTATATE should be considered for inoperable cardiac paraganglioma. No major hemodynamic complications were experienced. Therapy resulted in safety and substantially improved quality of life.