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Peptidrezeptorvermittelte Radiotherapie (PRRT) neuroendokriner Tumoren

Klinische Indikationen und Erfahrung mit 90Yttrium-markierten Somatostatinanaloga

Radionuclide treatment (peptide receptor radiotherapy) of neuroendocrine tumors

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Der Onkologe Aims and scope

Zusammenfassung

Die radioaktive Markierung spezifischer Peptide, die gezielt an Somatostatinrezeptoren auf neuroendokrinen Tumoren binden, ermöglicht eine interne Strahlentherapie, die unter weitgehender Schonung des gesunden Gewebes (strahlenexponiert wird im Wesentlichen nur die Niere und erheblich weniger das Knochenmark) und meist nur geringer Belastung des Patienten mehrfach durchgeführt wird. Die Radiorezeptortherapie eignet sich besonders für Patienten mit langsam wachsenden hepatischen und extrahepatischen Metastasen bzw. Tumoren, die erfahrungsgemäß für eine Chemotherapie weniger geeignet und bei denen die chirurgischen Möglichkeiten der Tumorresektion erschöpft sind. Auch Patienten, die einen Progress der Erkrankung unter Octreotidtherapie bzw. kombinierter Biotherapie aufweisen, und solche mit ausgeprägter klinischer Symptomatik trotz hoch dosierter Hormontherapie kommen für eine Radiorezeptortherapie in Betracht. Die Behandlungsergebnisse der PRRT aus verschiedenen europäischen Zentren sowie von Multizenterstudien zeigen eine hohe Tumoransprechrate und einen signifikant positiven Effekt auf die klinische Symptomatik.

Abstract

Radiolabeling of specific peptides which bind to somatostatin receptors on neuroendocrine tumors facilitates internal radionuclide therapy at low radiation risk for normal tissues (there is only a significant radiation burden to the kidneys and to a much lesser extent to the bone marrow), which can be repeatedly performed with little harm to the patient. Especially those patients with slowly growing hepatic and extrahepatic metastases (which are a poor target for chemotherapy) and those in whom all surgical options have been used are good candidates for peptide receptor radiotherapy (PRRT). Also patients who are progressing under octreotide therapy or under combined biotherapy and those with persisting symptoms (diarrhea, flush) despite high-dose hormonal therapy are suitable for peptide receptor radiotherapy. The results obtained in several European oncology centers as well as in multicenter trials show a promising tumor response rate and a significant improvement of clinical symptoms after PRRT.

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Danksagung

Mein besonderer Dank gilt Herrn Prof. Dr. rer. nat. Helmut Mäcke, der mit seinen Forschungsarbeiten und seiner radiochemischen Arbeitsgruppe der Nuklearmedizin ein neues Feld für die Radionuklidtherapie mit rezeptorgerichteten Substanzen eröffnete und die erste therapeutische Anwendung von 90Yttrium-DOTA-TOC (im August 1997) in Deutschland ermöglichte. Weiterhin Dank allen Mitarbeiterinnen der Klinik für Nuklearmedizin (insbesondere der Radiopharmazie und der Isotopentherapiestation) für ihren unermüdlichen Einsatz sowie allen beteiligten Kollegen für die exzellente Kooperation.

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Authors and Affiliations

  1. Klinik für Nuklearmedizin/PET-Zentrum, Zentralklinik Bad Berka

    R. P. Baum, J. Söldner, M. Schmücking & A. Niesen

  2. Klinik für Nuklearmedizin/PET-Zentrum, Zentralklinik Bad Berka GmbH, 99437 , Bad Berka

    R. P. Baum

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  1. R. P. Baum
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  2. J. Söldner
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  3. M. Schmücking
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  4. A. Niesen
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Correspondence to R. P. Baum.

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Herrn Prof. emer. Dr. med. A. Enke, Frankfurt/Main, zum 70. Geburtstag.

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Baum, R.P., Söldner, J., Schmücking, M. et al. Peptidrezeptorvermittelte Radiotherapie (PRRT) neuroendokriner Tumoren. Onkologe 10, 1098–1110 (2004). https://doi.org/10.1007/s00761-004-0771-7

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