Nuclear Medicine Unit Endocrinology Department, Jagiellonian University, Medical College, Cracow, Poland.
Eur J Nucl Med Mol Imaging. 2011 Sep;38(9):1669-74. doi: 10.1007/s00259-011-1835-8. Epub 2011 May 11.
Neuroendocrine tumours (NET) are a heterogeneous group of neoplasms of diffuse neuroendocrine cells. Surgery is the main aim in the treatment of NETs, which becomes impossible in the case of large tumours or infiltration into other tissues and/or important blood vessels. Neoadjuvant therapy might be helpful in decreasing NET size also, leading us to the point where a tumour, previously considered inoperable, becomes operable. The aim of the study was to assess the usage of peptide receptor radionuclide therapy (PRRT) as a neoadjuvant treatment, enabling surgical intervention in primary inoperable NET.
Among 47 patients treated with PRRT, 6 patients were chosen with large, inoperable tumours, for whom enabling of complete surgical excision of the lesions might offer the prospect for a cure. Response to the therapy was assessed according to Response Evaluation Criteria In Solid Tumors (RECIST).
The mean tumour size decreased from 6.9 (min. 3.1 cm, max. 9.6 cm) before therapy to 5.4 cm (min. 3.1 cm, max. 9.5 cm) after the treatment. According to RECIST, stabilization of the disease was observed in four and partial responses in two patients. In two patients, reduction of the tumour size enabled surgical intervention.
(1) PRRT might be considered a neoadjuvant therapy in primary inoperable NETs. (2) According to RECIST, stabilization of the disease was observed in the majority of patients. (3) We suggest that not only tumour diameter changes, but also tumour volume and contrast enhancement changes in computed tomography should be taken into consideration in assessment of the response to the therapy. (4) Somatostatin receptor scintigraphy is an important tool for qualification of the radioisotope therapy and also for the assessment of the response to PRRT.
神经内分泌肿瘤（NET）是弥漫性神经内分泌细胞的一组异质性肿瘤。手术是 NET 治疗的主要目的，但对于大肿瘤或浸润到其他组织和/或重要血管的肿瘤则无法进行手术。新辅助治疗也可能有助于缩小 NET 的大小，使我们能够达到这样一个地步：以前被认为无法手术的肿瘤变得可以手术。本研究的目的是评估肽受体放射性核素治疗（PRRT）作为新辅助治疗的作用，使以前无法手术的原发性 NET 能够进行手术干预。
在接受 PRRT 治疗的 47 名患者中，选择了 6 名患有大的、无法手术的肿瘤的患者，他们完全切除病变可能有治愈的机会。根据实体瘤反应评估标准（RECIST）评估治疗反应。
肿瘤大小的平均值从治疗前的 6.9cm（最小 3.1cm，最大 9.6cm）降至治疗后的 5.4cm（最小 3.1cm，最大 9.5cm）。根据 RECIST，4 名患者疾病稳定，2 名患者部分缓解。在 2 名患者中，肿瘤大小的缩小使手术干预成为可能。
（1）PRRT 可被视为原发性不可手术 NET 的新辅助治疗。（2）根据 RECIST，大多数患者观察到疾病稳定。（3）我们建议，在评估治疗反应时，不仅要考虑肿瘤直径的变化，还要考虑肿瘤体积和 CT 增强的变化。（4）生长抑素受体闪烁显像术是进行放射性核素治疗定性和评估 PRRT 反应的重要工具。
