Kjaer Andreas, Knigge Ulrich
Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging , Copenhagen , Denmark.
Scand J Gastroenterol. 2015 Jun;50(6):740-7. doi: 10.3109/00365521.2015.1033454.
Radionuclides are needed both for nuclear medicine imaging as well as for peptide-receptor radionuclide therapy (PRRT) of neuroendocrine tumors (NET). Imaging is important in the initial diagnostic work-up and for staging NETs. In therapy planning, somatostatin receptor imaging (SRI) is used when treatment is targeted at the somatostatin receptors as with the use of somatostatin analogues or PRRT. SRI with gamma camera technique using the tracer (111)In-DTPA-octreotide has for many years been the backbone of nuclear imaging of NETs. However, increasingly PET tracers for SRI are now used. (68)Ga-DOTATATE, (68)Ga-DOTATOC and (68)Ga-DOTANOC are the three most often used PET tracers. They perform better than SPECT tracers and should be preferred. FDG-PET is well suited for visualization of most of the somatostatin receptor-negative tumors prognostic in NET patients. Also (11)C-5-HTP, (18)F-DOPA and (123)I-MIBG may be used in NET. However, with FDG-PET and somatostatin receptor PET at hand we see limited necessity of other tracers. PRRT is an important tool in the treatment of advanced NETs causing complete or partial response in 20% and minor response or tumor stabilization in 60% with response duration of up to 3 years. Grade 3-4 kidney or bone marrow toxicity is seen in 1.5% and 9.5%, respectively, but are completely or partly reversible in most patients. (177)Lu-DOTATATE seems to have less toxicity than (90)Y-DOTATOC. However, until now only retrospective, non-randomized studies have been performed and the role of PRRT in treatment of NETs remains to be established.
核医学成像以及神经内分泌肿瘤（NET）的肽受体放射性核素治疗（PRRT）都需要放射性核素。成像在NET的初始诊断检查和分期中很重要。在治疗计划中，当使用生长抑素类似物或PRRT等针对生长抑素受体的治疗方法时，会使用生长抑素受体成像（SRI）。使用示踪剂（111）铟 - 二乙三胺五乙酸 - 奥曲肽的γ相机技术进行的SRI多年来一直是NET核成像的支柱。然而，现在越来越多地使用用于SRI的PET示踪剂。（68）镓 - 多柔比星、（68）镓 - 多西他赛和（68）镓 - 多纳曲肽是三种最常用的PET示踪剂。它们的表现优于SPECT示踪剂，应优先选用。氟代脱氧葡萄糖 - PET非常适合于NET患者中大多数生长抑素受体阴性肿瘤的预后可视化。此外，（11）碳 - 5 - 羟色氨酸、（18）氟 - 多巴和（123）碘 - 间碘苄胍也可用于NET。然而，有了氟代脱氧葡萄糖 - PET和生长抑素受体PET，我们认为其他示踪剂的必要性有限。PRRT是治疗晚期NET的重要工具，可使20%的患者产生完全或部分反应，60%的患者产生轻微反应或肿瘤稳定，反应持续时间长达3年。分别有1.5%和9.5%的患者出现3 - 4级肾脏或骨髓毒性，但大多数患者的毒性可完全或部分逆转。（177）镥 - 多柔比星的毒性似乎比（90）钇 - 多西他赛小。然而，到目前为止仅进行了回顾性、非随机研究，PRRT在NET治疗中的作用仍有待确定。
