Bodei Lisa, Modlin Irvin M, Luster Markus, Forrer Flavio, Cremonesi Marta, Hicks Rodney J, Ezziddin Samer, Kidd Mark, Chiti Arturo
Department of RadiologyMemorial Sloan Kettering Cancer Center, New York, New York, USA LuGenIum Consortium for Independent ResearchMilan, Rotterdam, Bad Berka, London
LuGenIum Consortium for Independent ResearchMilan, Rotterdam, Bad Berka, London Emeritus Professor Gastroenterological SurgeryYale University, School of Medicine, New Haven, Connecticut, USA.
Endocr Relat Cancer. 2016 Aug;23(8):C1-7. doi: 10.1530/ERC-16-0258. Epub 2016 Jun 28.
Peptide receptor radionuclide therapy (PRRT) with (90)Y-octreotide or (177)Lu-octreotate is an effective treatment for inoperable or metastatic neuroendocrine tumors (NETs), particularly well-differentiated gastroenteropancreatic or bronchopulmonary NETs. PRRT is generally extremely well tolerated, with modest toxicity to target organs, kidney and bone marrow. Nevertheless, a priori concerns regarding long-term effects lead clinicians such as Brieau and coworkers, in this ERC issue, to ascribe to the combination of alkylating agents and PRRT the apparently high occurrence (n=4) of myeloproliferative events (therapy-related myeloid neoplasms (t-MNs)) in a small cohort of 20 progressive, advanced digestive NETs treated with PRRT after chemotherapy. Anecdotal reports of myelotoxic events should be placed in the correct perspective of larger series, where the reported incidence of these events is ~2%, with the aim of promoting a balanced awareness of the issue and unbiased and reasonable overall conclusions. For a comprehensive definition of the issue, we provide an evaluation of the occurrence of t-MN in patients treated with various myelotoxic treatments.
使用钇-90奥曲肽或镥-177奥曲肽的肽受体放射性核素治疗（PRRT）是治疗无法手术切除或转移性神经内分泌肿瘤（NETs）的有效方法，尤其是高分化的胃肠胰或支气管肺NETs。PRRT通常耐受性极佳，对靶器官、肾脏和骨髓的毒性较小。然而，对长期影响的先验担忧使得像布里奥及其同事这样的临床医生在本期欧洲研究委员会（ERC）的文章中，将一小群20例接受化疗后再进行PRRT治疗的进展期、晚期消化性NETs中明显高发（n = 4）的骨髓增殖性事件（治疗相关髓系肿瘤（t-MNs））归因于烷化剂与PRRT的联合使用。骨髓毒性事件的轶事报道应放在更大规模研究的正确背景下看待，在这些研究中，这些事件的报告发生率约为2%，目的是促进对该问题的平衡认识以及得出无偏见且合理的总体结论。为全面定义该问题，我们对接受各种骨髓毒性治疗的患者中t-MN的发生情况进行了评估。
