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Der Nuklearmediziner 2003; 26(2): 121-133
DOI: 10.1055/s-2003-41792
Gastrointestinale Diagnostik

© Georg Thieme Verlag Stuttgart · New York

Nuklearmedizinische Diagnostik und Therapie neuroendokriner Tumoren des Gastrointestinaltraktes einschließlich des Karzinoides

Nuclear Medicine Diagnosis and Therapy of Neuroendocrine Tumors of the Gastrointestinal Tract, including CarcinoidsT. M. Behr1 , P. H. Kann 2 , M. Gotthardt1 , M. Béhé1 , R. Arnold3
  • 1Klinik für Nuklearmedizin
  • 2Bereich für Endokrinologie & Diabetologie
  • 3Klinik für Gastroenterologie, Stoffwechsel, Endokrinologie der Philipps-Universität Marburg
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Publication History

Publication Date:
08 September 2003 (online)

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Zusammenfassung

Neuroendokrine Tumoren des Gastrointestinaltrakts sind insbesondere seit der Entdeckung, dass diese Rezeptoren für regulatorische Peptide zuverlässig überexprimieren, die Domäne nuklearmedizinischer Diagnostik, in jüngerer Zeit auch nuklearmedizinischer Therapie geworden. Regulatorische Peptide sind kleine, leicht diffundierende, potente natürliche Substanzen mit einem weiten Spektrum rezeptorvermittelter Wirkungen. Hochaffine Rezeptoren für diese Peptide werden auf vielen Tumoren (über-)exprimiert, und diese Rezeptoren stellen neue molekulare Ziele zur Tumordiagnostik und -therapie dar. Während die historisch ältere MIBG-Szintigraphie nur begrenzte Sensitivität (bzw. in therapeutischer Applikation begrenzte Effektivität) gezeigt hat, hat die Somatostatin-Rezeptorszintigraphie das Staging (bzw. die Therapie) neuroendokriner gastroenteropankreatischer Tumoren revolutioniert. Physiologischerweise binden diese Peptide an G-Protein assoziierte Rezeptoren in der Zellmembran. Historisch gesehen sind die Somatostatin-Analoga die erste Klasse rezeptorbindender Peptide mit weiter klinischer Anwendung. 111Indium-DTPA-[D-Phe1]-Octreotid ist das erste und einzige Radiopeptid, das bislang in Europa und den Vereinigten Staaten Zulassung durch die entsprechenden Arzneimittelbehörden bekommen hat. Extensive klinische Studien mit vielen tausend Patienten konnten zeigen, dass die Hauptanwendung der Somatostatin- Rezeptorszintigraphie in der Detektion und im Staging gastroenteropankreatischer neuroendokriner Tumoren (Karzinoide u. a.) liegt. Bei diesen Tumoren ist die Octreotid- Szintigraphie jeder anderen Staging-Methode überlegen. Eine Vielzahl neuer radioaktiv markierter regulatorischer Peptide ist in Entwicklung, die an andere, neue Rezeptortypen binden. Radioaktiv markiertes vasoaktives intestinales Peptid (VIP), Gastrin- und Cholecystokinin-Derivate, Gastrin-releasing-peptide/Bombesin, Neurotensin, Substanz P, Glucagon-like peptide-1 (GLP-1)- Analoga und neuerdings auch an-Somatostatin-Rezeptorliganden stehen in unterschiedlich fortgeschrittenen Phasen der präklinischen und teilweise bereits klinischen Entwicklung. Radioaktiv markierte regulatorische Peptide haben neue Horizonte in der Nuklearonkologie zur Diagnostik und möglicherweise auch Therapie eröffnet.

Abstract

Neuroendocrine tumors of the gastrointestinal tract are the special domain of Nuclear Medical diagnosis and therapy, especially since they have been recognized as overexpressing receptors for regulatory peptides. Regulatory peptides are small, readily diffusible and potent natural substances with a wide spectrum of receptor-mediated actions. High affinity receptors are reliably (over-) expressed on a variety of tumors, and these receptors represent novel molecular targets for tumor diagnosis and therapy. Whereas the historically more ancient MIBG scintigraphy showed only limited sensitivity and therapeutic efficacy, somatostatin receptor scintigraphy has revolutionized the staging of gastroenteropancreatic tumors. Physiologically, these peptides bind to’G-protein associated receptors in the cell membranes. Historically, somatostatin analogues are the first class of receptor-binding peptides with a broader field of clinical applications. In-111-DTPA-[D- Phe1]-octreotide is the first and only radiopeptide having gained approval by the respective regulatory agencies in Europe and the United States of America. Extensive clinical studies with several thousands of patients were able to show that the main application of somatostatin receptor scintigraphy lies in the detection and the staging of gastroenteropancreatic neuroendocrine tumors (carcinoids and others). In these, radiolabeled octreotide is superior to all other forms or methods of staging. A variety of novel radiolabeled regulatory peptides is in development, binding to other, novel receptor types. Radiolabeled vasoactive intestinal peptide (VIP), gastrin and cholecystokinin derivatives, gastrin-releasing peptide/bombesin, neurotensin, substance P, glucagon-like peptide-1 (GLP-1) analogues and potentially also pan-somatostatin receptor ligands stay in differently developed stages of their pre-clinical or even clinical testing. Radiolalebeled regulatory peptides have opened new horizons in Nuclear oncology for diagnosis and potential therapy.

Schlüsselwörter

Neuroendokrine Tumoren - Karzinoide - regulatorische Peptid(hormon)e - Peptidhormonrezeptoren - Somatostatin - Gastrin - Radioligandtherapie

Key words

Neuroendocrine tumors - carcinoids - regulatory peptide(hormone)s - peptide (hormone) receptors - somatostatin - gastrin - radioligand therapy

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Prof. Dr. Thomas Behr

Klinik für Nuklearmedizin Philipps-Universität Marburg

Baldingerstr.

35043 Marburg/Lahn

Phone: +49/6421-28-62815

Fax: +49/6421-67025

Email: tmbehr@staff.uni-marburg.de

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