Giammarile Francesco
Nuclear Medicine and Diagnostic Imaging Section, Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna International Centre, PO Box 100, 1400 Vienna, Austria.
Hell J Nucl Med. 2023 May-Aug;26 Suppl:42-43.
Theranostics is an emerging field in medicine that combines diagnostics and therapeutics into a single approach. Overall, theranostics represents a promising paradigm for personalized medicine, as it allows for targeted and precise treatment based on individual patient characteristics. In nuclear medicine, theranostics involves the use of radiopharmaceuticals that have both diagnostic and therapeutic properties. Moreover, theranostics in nuclear medicine offers several advantages over traditional cancer treatments. Unlike radiotherapy, in nuclear medicine the therapy is systemic that targets both primary tumors and metastatic lesions, offering a more comprehensive treatment approach. Additionally, nuclear medicine therapy has been shown to have fewer side effects compared to traditional chemotherapy, making it a more tolerable treatment option for patients. While theranostics in nuclear medicine is still a relatively new field, it has shown promising results in the treatment of neuroendocrine tumors (NETs). One example of a theranostic approach in nuclear medicine is the use of radiolabeled somatostatin analogs for the treatment of NETs. Somatostatin is a hormone that regulates the release of other hormones in the body. It also binds to somatostatin receptors, which are highly expressed in NETs. The first step in theranostics for NETs is the diagnosis and staging of the disease using a radiolabeled somatostatin analog and PET/CT imaging. This allows for the detection of the tumor and assessment of its size and location. Once the tumor has been identified, the same radiolabeled somatostatin analog can be used as a therapeutic agent. The radiopharmaceutical delivers radiation directly to the tumor cells, which destroys them while sparing surrounding healthy tissue. This is known as peptide receptor radionuclide therapy (PRRT). The use of theranostics in NETs also involves the identification of specific somatostatin receptor subtypes that are expressed in the tumor cells. This is important as different somatostatin analogs have varying affinities for different receptor subtypes. By selecting the appropriate radiolabeled somatostatin analog, clinicians can increase the specificity of the therapy, delivering radiation to the tumor cells while minimizing damage to healthy tissue. PRRT has been shown to be effective in treating NETs, particularly those that are resistant to other forms of treatment. It can also be used in combination with other therapies, such as chemotherapy and surgery, to improve outcomes. As research continues, it is likely that theranostics in nuclear medicine will become an increasingly important tool in the fight against cancer, particularly in the context of NETs, offering personalized, targeted treatment options that improve patient outcomes.
治疗诊断学是医学领域中一个新兴的学科,它将诊断与治疗整合为一种单一的方法。总体而言,治疗诊断学是个性化医疗的一个很有前景的范例,因为它可以根据患者的个体特征进行有针对性的精准治疗。在核医学中,治疗诊断学涉及使用兼具诊断和治疗特性的放射性药物。此外,核医学中的治疗诊断学相比传统癌症治疗方法具有若干优势。与放射疗法不同,在核医学中,治疗是全身性的,既能靶向原发性肿瘤,也能靶向转移性病灶,提供了一种更全面的治疗方法。此外,与传统化疗相比,核医学治疗已被证明副作用更少,这使其成为患者更能耐受的治疗选择。虽然核医学中的治疗诊断学仍是一个相对较新的领域,但它在神经内分泌肿瘤(NETs)的治疗中已显示出有前景的结果。核医学中一种治疗诊断方法的例子是使用放射性标记的生长抑素类似物来治疗NETs。生长抑素是一种调节体内其他激素释放的激素。它还能与生长抑素受体结合,而生长抑素受体在NETs中高度表达。NETs治疗诊断学的第一步是使用放射性标记的生长抑素类似物和PET/CT成像对疾病进行诊断和分期。这有助于检测肿瘤并评估其大小和位置。一旦识别出肿瘤,相同的放射性标记生长抑素类似物就可用作治疗剂。放射性药物将辐射直接传递给肿瘤细胞,在不损伤周围健康组织的情况下破坏肿瘤细胞。这被称为肽受体放射性核素治疗(PRRT)。在NETs中使用治疗诊断学还涉及识别肿瘤细胞中表达的特定生长抑素受体亚型。这一点很重要,因为不同的生长抑素类似物对不同的受体亚型具有不同的亲和力。通过选择合适的放射性标记生长抑素类似物,临床医生可以提高治疗的特异性,在将辐射传递给肿瘤细胞的同时,将对健康组织的损害降至最低。PRRT已被证明在治疗NETs方面是有效的,尤其是对那些对其他治疗形式耐药的NETs。它也可以与其他疗法,如化疗和手术联合使用,以改善治疗效果。随着研究的不断深入,核医学中的治疗诊断学很可能会成为对抗癌症,特别是在NETs背景下的一种越来越重要的工具,提供个性化、有针对性的治疗选择,从而改善患者的治疗效果。
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