Radiation Medicine Centre, Bhabha Atomic Research Centre, Tata Memorial Hospital Annexe, Mumbai, India; Homi Bhabha National Institute, Mumbai, India.
Radiation Medicine Centre, Bhabha Atomic Research Centre, Tata Memorial Hospital Annexe, Mumbai, India; Homi Bhabha National Institute, Mumbai, India.
Semin Nucl Med. 2020 Sep;50(5):447-464. doi: 10.1053/j.semnuclmed.2020.05.004. Epub 2020 Jul 3.
Peptide receptor radionuclide therapy (PRRT), over the years, has evolved as an important modality in the therapeutic armamentarium of advanced, metastatic or inoperable, progressive Neuroendocrine Neoplasms (NENs). This review deliberates on the basic understanding and applied clinical aspects of PRRT in NENs, with special reference to (1) tumor biology and receptor characteristics, (2) molecular PET-CT imaging (in particular the invaluable role of dual-tracer PET with [Ga]-DOTA-TATE/NOC and [F]-FDG for exploring tumor biology in continuum and individualizing treatment decision making) and NEN theranostics, (3) relevant radiochemistry of different therapeutic radionuclides (both beta emitting Lu-DOTATATE and Y-DOTATATE and alpha emitting Ac-DOTATATE), and (4) related dosimetric considerations. Successful clinical management of the NENs would require multifactorial considerations, and all the aforementioned points pertaining to the disease process and available logistics are key considerations for state-of-the-art clinical practice and delivering personalized care in this group of patients. Emphasis has been placed on relatively intriguing areas such as (1) NET grade 3 of WHO 2017 classification (ie, Ki-67>20% but well-differentiation features), (2) "Neoadjuvant PRRT," (3) combining chemotherapy and PRRT, (4) 'Sandwich Chemo-PRRT', (5) duo-PRRT and tandem PRRT, (6) resistant functioning disease with nuances in clinical management and how one can advocate PRRT rationally in such clinical settings and individualize the management in a patient specific manner. Relevant clinical management issues related to some difficult case scenarios, which the Nuclear Medicine attending physician should be aware of to run an efficient clinical PRRT services, are described.
肽受体放射性核素治疗 (PRRT) 多年来已发展成为治疗晚期、转移性或不可手术、进展性神经内分泌肿瘤 (NEN) 的重要手段之一。本文详细讨论了 PRRT 在 NEN 中的基本理解和应用临床方面，特别参考了 (1) 肿瘤生物学和受体特征、(2) 分子 PET-CT 成像 (特别是双示踪剂 [Ga]-DOTA-TATE/NOC 和 [F]-FDG 的宝贵作用，用于连续探索肿瘤生物学和个体化治疗决策) 和 NEN 治疗学、(3) 不同治疗性放射性核素的相关放射化学 (包括发射β射线的 Lu-DOTATATE 和 Y-DOTATATE 以及发射α射线的 Ac-DOTATATE)，以及 (4) 相关剂量学考虑因素。NEN 的成功临床管理需要多方面的考虑，上述与疾病过程和现有物流相关的所有要点都是该疾病患者进行临床实践和提供个性化护理的关键。本文重点关注了一些相对有趣的领域，如 (1) 2017 年 WHO 分级 3 的神经内分泌肿瘤 (即 Ki-67>20%但具有良好分化特征)、(2) “新辅助 PRRT”、(3) 联合化疗和 PRRT、(4) “夹心 Chemo-PRRT”、(5) duo-PRRT 和串联 PRRT、(6) 耐药功能性疾病的临床管理中的细微差别，以及如何在这些临床环境下合理主张 PRRT 并以患者特异性的方式进行个体化管理。还描述了与一些困难病例场景相关的相关临床管理问题，核医学主治医生应该了解这些问题，以便有效地开展临床 PRRT 服务。
