Cremonesi M, Botta F, Di Dia A, Ferrari M, Bodei L, De Cicco C, Rossi A, Bartolomei M, Mei R, Severi S, Salvatori M, Pedroli G, Paganelli G
Medical Physics, European Institute of Oncology, Milan, Italy.
Q J Nucl Med Mol Imaging. 2010 Feb;54(1):37-51.
Peptide Receptor Radionuclide Therapy (PRRT) has proven its efficacy in the treatment of neuroendocrine and other somatostatin receptor expressing tumours (SR-tumours). Several clinical trials have confirmed that adverse effects are represented by possible renal impairment, which is the major concern, and low but not absent hematological toxicity. High kidney irradiation is a constant, despite the sparing of dose obtained by renal protectors. Hematological toxicity, although low, needs to be monitored. The clinical and dosimetry results collected in more than a decade have recognized weak points to unravel, increased knowledge, offering new views. When planning therapy with radiopeptides, the large patients' variability as for biodistribution and tumour uptake must be taken into account in order to tailor the therapy, or at least to avoid foreseeable gross treatments. Reliable and personalized dosimetry is more and more requested. This paper reviews through the literature the methods to study the biokinetics, the dosimetry outcomes, some clue information and correlations obtained once applying the radiobiological models. Special focus is given on recent improvements and indications for critical organ protection that light up challenging perspectives for PRRT.
肽受体放射性核素治疗（PRRT）已在神经内分泌肿瘤及其他表达生长抑素受体的肿瘤（SR肿瘤）的治疗中证明了其疗效。多项临床试验证实，不良反应表现为可能出现的肾脏损害（这是主要关注点）以及程度较轻但并非不存在的血液学毒性。尽管使用肾脏保护剂可减少剂量，但肾脏的高辐射剂量一直存在。血液学毒性虽低，但仍需监测。十多年来收集的临床和剂量学结果已识别出有待解决的薄弱环节，增加了相关知识，提供了新的观点。在规划放射性肽治疗时，必须考虑到患者在生物分布和肿瘤摄取方面的巨大差异，以便调整治疗方案，或者至少避免可预见的过度治疗。人们对可靠且个性化的剂量学要求越来越高。本文通过文献综述了研究生物动力学的方法、剂量学结果、应用放射生物学模型后获得的一些线索信息及相关性。特别关注了近期的改进以及关键器官保护的指征，这些为PRRT带来了具有挑战性的前景。
