Welche neuen PET-Tracer braucht die Strahlentherapie?

Zusammenfassung

Im Rahmen der Optimierung von Diagnostik und Therapie, u. a. der Bestrahlungstherapie, gewinnt in der Radioonkologie neben der [¹⁸F]FDG-Positronenemissiontomografie/Computertomografie (PET bzw. PET/CT) die PET/CT mit neuen Tracern zunehmend an Bedeutung.

Der Einsatz von [¹⁸F]Fluorothymidin ([¹⁸F]FLT) als Proliferationsmarker, [¹⁸F]Fluoromisonidazol ([¹⁸F]FMISO) und [¹⁸F]Fluoroazomycin-Arabinosid ([¹⁸F]FAZA) als Hypoxietracer, [¹⁸F]Fluoroethyltyrosin, ([¹⁸F]FET) und [¹¹C]Methionin für die Hirntumorbildgebung, [⁶⁸Ga]DOTATOC für die Somatostatinrezeptorbildgebung, [¹⁸F]FDOPA für die Dopaminsynthese und radioaktiv markierter Cholinderivate zur Phospholipidstoffwechsel-Bildgebung ist vielversprechend. Einige dieser neuen Tracer jenseits der FDG werden für radioonkologische Fragestellungen eingesetzt; so ist z. B. die Aminosäure-PET und -PET/CT hilfreich für eine optimierte Bestrahlungsplanung bei hirneigenen Tumoren, da FET und MET mit hoher Genauigkeit die Abgrenzung des Tumorgewebes vom Normalgewebe erlauben. Zukünftig wird die Etablierung und Validierung neuer Tracer für die Klinik, insbesondere auch für die Strahlentherapie, von Bedeutung sein. Tumorhypoxie bereitet im Rahmen der Bestrahlungsplanung therapeutische Schwierigkeiten. Die Hypoxiebildgebung könnte im Rahmen einer Intensitätsmodulierten Bestrahlungsplanung (IMRT) zu einer Therapieoptimierung beitragen.

Zudem haben Fortschritte in der Hybridbildgebungstechnologie der PET/MR hohes Potenzial in der bildgebenden Onkologie aufgrund der Synergie molekularer Information der PET mit dem höheren Weichteilkontrast, niedriger Strahlenbelastung und der Möglichkeit der morphologischen und funktionellen Bildgebung der MRT.

Abstract

PET and PET/CT with innovative tracers gain increasing importance in diagnosis and therapy management, and radiation treatment planning in radio-oncology besides the widely established FDG. The introduction of [¹⁸F]Fluorothymidine ([¹⁸F]FLT) as marker of proliferation, [¹⁸F]Fluoromisonidazole ([¹⁸F]FMISO) and [¹⁸F]Fluoroazomycin-Arabinoside ([¹⁸F]FAZA) as tracer of hypoxia, [¹⁸F]Fluoroethyltyrosine ([¹⁸F]FET) and [¹¹C]Methionine for brain tumour imaging, [⁶⁸Ga]DOTATOC for somatostatin receptor imaging, [¹⁸F]FDOPA for dopamine synthesis and radioactively labeled choline derivatives for imaging phospholipid metabolism have opened novel approaches to tumour imaging. Some of these tracers have already been implemented into radio-oncology: Amino acid PET and PET/CT have the potential to optimise radiation treatment planning of brain tumours through accurate delineation of tumour tissue from normal tissue, necrosis and edema. Hypoxia represents a major therapeutic problem in radiation therapy. Hypoxia imaging is very attractive as it may allow to increase the dose in hypoxic tumours potentially allowing for a better tumour control. Advances in hybrid imaging, i. e. the introduction of MR/PET, may also have an impact in radio-oncology through synergies related to the combination of molecular signals of PET and a high soft tissue contrast of MRI as well as functional MRI capabilities.

Schlüsselwörter

PET/CT - innovative Tracer - Cholin - Bestrahlungsplanung

Keywords

PET/CT - novel tracer - choline - radiation treatment planning

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