Van Essen Martijn, Krenning Eric P, De Jong Marion, Valkema Roelf, Kwekkeboom Dik J
Department of Nuclear Medicine, Erasmus MC, 's Gravendijkwal 230, Rotterdam, CE, the Netherlands.
Acta Oncol. 2007;46(6):723-34. doi: 10.1080/02841860701441848.
Peptide Receptor Radionuclide Therapy (PRRT) with radiolabelled somatostatin analogues is a promising treatment option for patients with inoperable or metastasised neuroendocrine tumours. Symptomatic improvement may occur with all of the various (111)In, (90)Y, or (177)Lu-labelled somatostatin analogues that have been used. Since tumour size reduction was seldom achieved with (111)Indium labelled somatostatin analogues, radiolabelled somatostatin analogues with beta-emitting isotopes like (90)Y and (177)Lu were developed. Reported anti-tumour effects of [(90)Y-DOTA(0),Tyr(3)]octreotide vary considerably between various studies: Tumour regression of 50% or more was achieved in 9 to 33% (mean 22%). With [(177)Lu-DOTA(0),Tyr(3)]octreotate treatments, tumour regression of 50% or more was achieved in 28% of patients and tumour regression of 25 to 50% in 19% of patients, stable disease was demonstrated in 35% and progressive disease in 18%. Predictive factors for tumour remission were high tumour uptake on somatostatin receptor scintigraphy and limited amount of liver metastases. The side-effects of PRRT are few and mostly mild, certainly when using renal protective agents: Serious side-effects like myelodysplastic syndrome or renal failure are rare. The median duration of the therapy response for [(90)Y-DOTA(0),Tyr(3)]octreotide and [(177)Lu-DOTA(0),Tyr(3)]octreotate is 30 months and more than 36 months respectively. Lastly, quality of life improves significantly after treatment with [(177)Lu-DOTA(0),Tyr(3)]octreotate. These data compare favourably with the limited number of alternative treatment approaches, like chemotherapy. If more widespread use of PRRT is possible, such therapy might become the therapy of first choice in patients with metastasised or inoperable gastroenteropancreatic neuroendocrine tumours. Also the role in somatostatin receptor expressing non-GEP tumours, like metastasised paraganglioma/pheochromocytoma and non-radioiodine-avid differentiated thyroid carcinoma might become more important.
用放射性标记的生长抑素类似物进行肽受体放射性核素治疗(PRRT)是无法手术或已转移的神经内分泌肿瘤患者一种很有前景的治疗选择。使用过的各种铟-111(¹¹¹In)、钇-90(⁹⁰Y)或镥-177(¹⁷⁷Lu)标记的生长抑素类似物都可能出现症状改善。由于用铟-111标记的生长抑素类似物很少能使肿瘤缩小,因此开发了用发射β射线的同位素如钇-90和镥-177标记的生长抑素类似物。不同研究报道的[钇-90-四氮杂环十二烷四乙酸(0),酪胺酸(3)]奥曲肽的抗肿瘤效果差异很大:9%至33%(平均22%)的患者实现了50%或更大程度的肿瘤消退。在用[镥-177-四氮杂环十二烷四乙酸(0),酪胺酸(3)]奥曲肽治疗中,28%的患者实现了50%或更大程度的肿瘤消退,19%的患者实现了25%至50%的肿瘤消退,35%的患者疾病稳定,18%的患者疾病进展。肿瘤缓解的预测因素是生长抑素受体闪烁显像显示肿瘤摄取高以及肝转移数量有限。PRRT的副作用很少且大多轻微,尤其是在使用肾脏保护剂时:骨髓增生异常综合征或肾衰竭等严重副作用很少见。[钇-90-四氮杂环十二烷四乙酸(0),酪胺酸(3)]奥曲肽和[镥-177-四氮杂环十二烷四乙酸(0),酪胺酸(3)]奥曲肽治疗反应的中位持续时间分别为30个月和超过36个月。最后,用[镥-177-四氮杂环十二烷四乙酸(0),酪胺酸(3)]奥曲肽治疗后生活质量显著改善。这些数据与有限的其他治疗方法(如化疗)相比具有优势。如果PRRT能够更广泛地应用,这种治疗可能会成为转移性或无法手术的胃肠胰神经内分泌肿瘤患者的首选治疗方法。其在表达生长抑素受体的非胃肠胰肿瘤(如转移性副神经节瘤/嗜铬细胞瘤和非放射性碘摄取性分化型甲状腺癌)中的作用可能也会变得更加重要。