Abstract: A 43-year-old man with known superior mediastinal syndrome due to 99mTc HYNIC DOTA SPECT/CT and 18F-FDG PET tracer avid inoperable metastatic carcinoid received peptide receptor based radionuclide therapy (PRRT) with 177Lu-DOTATATE. Repeat evaluation at 3 months post-therapy demonstrated stable disease with alleviation of patient’s symptoms and remarkable improvement in the quality of life. PRRT with 177Lu-DOTATATE may be an option for inoperable mediastinal carcinoids with superior mediastinal syndrome.