Version July 2025
dotatate: tyrosine-3-octreotate; LAR: long-acting release; RT: radiation therapy.
* All patients with confirmed catecholamine-secreting tumors must receive appropriate alpha- and beta-adrenergic blockage prior to initiating therapy for the primary tumor and associated metastatic disease to block the effects from possible massive catecholamine secretion. For specific details, refer to UpToDate content on treatment of pheochromocytoma.
¶ Coordinating resection of the primary tumor and metastatic disease depends upon the location of the metastases and the length of the necessary anesthesia session. Primary tumors and metastatic disease that are proximally located can typically be resected during the same operation. For tumors that are not completely resectable, one option for tumor debulking is cytoreductive (R2) resection, with or without locoregional therapies, such as RT or ablation.
Δ Percutaneous ablation can treat metastatic lesions at a variety of sites, including soft tissue, bone, and liver. Techniques include radiofrequency ablation, cryoablation therapy, thermal ablation, or ethanol injection.
◊ RT can be used to treat bulky, symptomatic disease, particularly painful bone metastases.
§ Surveillance includes monitoring blood pressure and biochemical markers every 3 to 4 months. Imaging is obtained earlier for symptomatic patients and less frequently for those with stable disease and no new symptoms.
¥ Tumors must be somatostatin receptor positive.
