Auernhammer Christoph J, Göke Burkhard
Department of Internal Medicine II, Hospital of the University of Munich, Ludwig-Maximilians-University Munich, Munich-Grosshadern, Germany.
Wien Klin Wochenschr. 2007;119(19-20):609-15. doi: 10.1007/s00508-007-0877-1.
Gastrinomas are functional neuroendocrine tumors of the gastroenteropancreatic system. Surgery is first line treatment in gastrinomas, however often fails to be curative. This manuscript reviews current strategies of medical treatment of surgically non-curable gastrinoma. Symptomatic treatment with H(+)-K(+)-ATPase proton-pump inhibitors suppresses hypersecretion of gastric acid and substantially improves quality of life in patients with Zollinger-Ellison syndrome. Further medical therapy is only recommended in cases of progressive metastatic gastrinoma. In well differentiated neuroendocrine carcinoma (G1 and G2) a so-called biotherapy with somatostatin analogues exists as first-line and chemotherapy with streptocotozin plus doxorubicine/5-FU as second-line medical treatment option. In poorly differentiated neuroendocrine carcinoma (G3) chemotherapy with etoposide plus cisplatin is possible. Prospective future therapeutic strategies may include treatment with novel somatostatin analogues as well as angiogenesis inhibitors and kinase inhibitors targeting tumor-specific signaling cascades.
胃泌素瘤是胃肠胰系统的功能性神经内分泌肿瘤。手术是胃泌素瘤的一线治疗方法，但往往无法治愈。本文综述了手术无法治愈的胃泌素瘤的当前药物治疗策略。使用H(+)-K(+)-ATP酶质子泵抑制剂进行对症治疗可抑制胃酸过度分泌，并显著改善卓-艾综合征患者的生活质量。仅在进行性转移性胃泌素瘤的情况下推荐进一步的药物治疗。在高分化神经内分泌癌（G1和G2）中，存在一种以生长抑素类似物进行的所谓生物治疗作为一线治疗，以链脲霉素加阿霉素/5-氟尿嘧啶进行化疗作为二线药物治疗选择。在低分化神经内分泌癌（G3）中，可以使用依托泊苷加顺铂进行化疗。未来可能的前瞻性治疗策略可能包括使用新型生长抑素类似物以及针对肿瘤特异性信号级联的血管生成抑制剂和激酶抑制剂进行治疗。
