Zielgerichtete, rezeptorvermittelte Radionuklidtherapie (Radiopeptidtherapie) neuroendokriner Tumoren

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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