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明天核医学有望取得什么成果?

What can be expected from nuclear medicine tomorrow?

作者信息

Barbet Jacques, Kraeber-Bodéré Françoise, Chatal Jean-François

机构信息

Centre de Recherche en Cancérologie Nantes-Angers, INSERM, Université de Nantes, Nantes, France.

出版信息

Cancer Biother Radiopharm. 2008 Aug;23(4):483-504. doi: 10.1089/cbr.2008.010-U.

Abstract

Imaging can take advantage of developments in "omics" approaches and go from routine individual biomarkers to multiple-scale biomarker profiles. Imaging structural, functional, metabolic, cellular, and molecular changes will be made possible by multimodality hybrid techniques, such as positron emission tomography-magnetic resonance imaging. Imaging should predict treatment response, look at stratification for specific treatment modalities, and look at the "omic" characterization of an individual patient or a specific tumor. This should lead to the development of "personalized" medicine. In cancer radiotherapy, patient responses should be accurately predicted. In specific cases, proton and hadrontherapy will be further enhanced by the irradiation dose delivered to the tumors. For disseminated or metastatic disease, targeted radionuclide therapy is an effective addition to the arsenal against cancer. The clinical efficacy of radiolabeled antibodies has been clearly demonstrated in lymphoma as well as that of radiolabeled peptides derived from somatostatin in the treatment of neuroendocrine tumors. Preliminary studies now show interesting results in solid tumors, too. Even if the number of objective clinical responses based on tumor shrinkage is small, targeted radionuclide therapy increases progression-free survival or overall survival in some specific cases where tumor burden is small. Avenues for further improvement are multiple and include combination with other therapeutic modalities, development of new approaches (e.g., small molecules, pretargeting, and antibody alternatives). Using alpha-emitting radionuclides is another possibility for specific diseases, such as leukemias, multiple myeloma, or brain tumor remnants.

摘要

成像可利用“组学”方法的进展,从常规的个体生物标志物转向多尺度生物标志物谱。多模态混合技术,如正电子发射断层扫描 - 磁共振成像,将使成像结构、功能、代谢、细胞和分子变化成为可能。成像应预测治疗反应,查看特定治疗方式的分层情况,并查看个体患者或特定肿瘤的“组学”特征。这将推动“个性化”医学的发展。在癌症放射治疗中,应准确预测患者的反应。在特定情况下,质子和强子疗法将通过向肿瘤输送的辐射剂量得到进一步增强。对于播散性或转移性疾病,靶向放射性核素疗法是抗癌武器库中的一种有效补充。放射性标记抗体在淋巴瘤中的临床疗效以及放射性标记的生长抑素衍生肽在神经内分泌肿瘤治疗中的临床疗效已得到明确证实。目前的初步研究在实体瘤中也显示出有趣的结果。即使基于肿瘤缩小的客观临床反应数量较少,但在某些肿瘤负荷较小的特定情况下,靶向放射性核素疗法可提高无进展生存期或总生存期。进一步改进的途径有多种,包括与其他治疗方式联合、开发新方法(如小分子、预靶向和抗体替代物)。对于特定疾病,如白血病、多发性骨髓瘤或脑肿瘤残留,使用发射α粒子的放射性核素是另一种可能性。

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