Bild-basierte Patienten-individuelle Dosimetrie bei internen Radionuklidtherapien von neuroendokrinen Tumoren

Zusammenfassung

Die Peptid-Radiorezeptor-Therapie (PRRT) mit Lutetium-177 (¹⁷⁷Lu) hat sich als vielversprechende Therapieoption von metastasierten neuroendokrinen Tumoren (NETs) etabliert. Des Weiteren wird die Yttrium-90 (⁹⁰Y) selektive interne Radio-Therapie (SIRT) als lokale Therapie von Lebermetastasen von NET Patienten durchgeführt. Beide Therapien werden von quantitativer Bildgebung begleitet und ermöglichen so Therapie-begleitende, Patienten-individuelle Dosimetrie. Die Abschätzung der Strahlendosis auf Risikoorgane und Tumore hat den großen Vorteil, dass weitere geplante Therapiezyklen möglicherweise angepasst werden können, um sowohl den Therapieerfolg zu verbessern, als auch die Nebenwirkung durch Toxizität von Risikoorganen zu minimieren. Die PRRT und SIRT unterscheiden sich sowohl in der Applikation, dem zugrundeliegenden therapeutischen Konzept, als auch den Radionukliden. Daraus resultieren verschiedene Anforderungen und Voraussetzungen für die Dosimetrie. Dieser Artikel beleuchtet detailliert die verschiedenen Herausforderungen für Bild-basierte Dosimetrie bei der PRRT und der SIRT von NET Patienten und unterstreicht die Notwendigkeit von routinemäßiger Dosimetrie.

Abstract

Peptide Receptor Radionuclide Therapy (PRRT) using Lutetium-177 (¹⁷⁷Lu) has become a promising therapeutic option for metastasized neuroendocrine tumors (NETs). In addition, selective internal radionuclide therapy (SIRT) using Yttrium-90 (⁹⁰Y) can serve as local therapy option for liver metastases of NET patients. Both therapies are accompanied by quantitative imaging which allows for pre- and post-therapeutic, patient-specific dosimetry. The estimation of absorbed radiation dose to organs at risk and tumors offers the potential that subsequent therapy cycles could be adapted to maximize therapy success while minimizing the risk of therapy related side effects or organ toxicities. PRRT and SIRT differ in application, underlying therapeutic concepts, and radionuclides, which leads to different demands and requirements for image-based dosimetry. This article reviews in detail the different challenges for image-based dosimetry for both, PRRT and SIRT, for NET patients. We further would like to underline the need for routine dosimetry.

Schlüsselwörter

NET - Peptid-Radiorezeptor-Therapie - PRRT - Lutetium-177 - Radioembolisation - SIRT - Yttrium-90 - quantitative Bildgebung - Dosimetrie

Keywords

NET - peptide receptor radionuclide therapy - PRRT - Lutetium-177 - radioembolization - SIRT - Yttrium-90 - quantitative imaging - dosimetry

^* Beide Autorinnen haben zu gleichen Teilen zu diesem Manuskript beigetragen.

Publication History

Article published online:
29 November 2021

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