Zusammenfassung
Die zielgerichtete, peptidvermittelte Radionuklidtherapie mit radioaktiv markierten
Somatostatinanalogen gewinnt zunehmend an Bedeutung in der Behandlung von metastasierten,
somatostatinrezeptorexprimierenden Tumoren. Die Verwendung radioaktiv markierter Somatostatine
zur Bildgebung ist zurzeit der Goldstandard zum Staging neuroendokriner Tumore. Da
der Somatostatinrezeptor durch die meisten neuroendokrinen Tumore stark überexprimiert
wird, kann ein sehr hohes Tumor zu Hintergrund Verhältnis erreicht werden. Es ist
daher nahe liegend in einem weiteren Schritt diese Tumore mit Radiopeptiden und höheren
Radioaktivitäten zu behandeln. Viele Patienten wurden bereits mit radioaktiven Somatostatinen
behandelt. Rund ein Viertel aller Patienten erfährt eine Tumorreduktion von mehr als
50 %. Schwere Nebenwirkungen sind selten und die Behandlung ist im Allgemeinen gut
verträglich. Dieser Artikel soll einen Überblick verschaffen über die Entstehung,
den gegenwärtigen Stand sowie über mögliche Entwicklungen dieser Behandlung in der
Zukunft. Außerdem soll die Indikationsstellung sowie die nötigen Voraussetzungen zu
einer solchen Therapie diskutiert werden.
Abstract
Peptide receptor radionuclide therapy with radiolabelled somatostatin analogues is
an emerging and convincing treatment modality for patients with unresectable, somatostatin
receptor-positive neuroendocrine tumours. Using radiolabelled somatostatin analogues
for imaging became the gold standard for staging of neuroendocrine tumours. The somatostatin
receptor is strongly over-expressed in most neuroendocrine tumours. This results in
high tumour to background ratios. Consequently, the next step was trying to treat
these patients by increasing the radioactivity of the administered radiolabelled somatostatin
analogue in an attempt to induce tumour cure. Many patients have been treated successfully
with this approach since then, roughly one quarter of them achieving objective tumour
shrinkage > 50 %. Serious side-effects were rare. To date, benefit is proven concerning
tumour mass, quality of life and survival. This article reviews the effectiveness
and safety of the different radiolabelled somatostatin analogues used. Furthermore,
clinical issues, including indication and timing of therapy, are discussed.
Schlüsselwörter
neuroendokrine Tumoren - Karzinoid - Somatostatinrezeptor - Radionuklidtherapie -
interne Radiotherapie
Key words
neuroendocrine tumors - carcinoid - somatostatin receptor - radionuclide therapy -
internal radiotherapy
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Dr. med. Dr.phil. F. Forrer
Nuklearmedizin · Universitätsspital Basel
Petersgraben 4
CH-4031 Basel
Schweiz
Phone: +41 / 61 / 2 65 47 04
Fax: +41 / 61 / 2 65 49 25
Email: fforrer@uhbs.ch
