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Der Nuklearmediziner 2011; 34(04): 226-233
DOI: 10.1055/s-0031-1295433
Neuroendokrine Tumoren
© Georg Thieme Verlag KG Stuttgart · New York

Therapie neuroendokriner Tumoren mit radioaktiv markierten Somatostatinanaloga

Treatment of Neuroendocrine Tumours with Radioactive Labelled Somatostatin Analogues
J. Geisler
1   Klinik und Poliklinik für Nuklearmedizin, Universitätsklinikum der Ludwig-Maximilians-Universität München
,
P. Bartenstein
1   Klinik und Poliklinik für Nuklearmedizin, Universitätsklinikum der Ludwig-Maximilians-Universität München
,
A. R. Haug
1   Klinik und Poliklinik für Nuklearmedizin, Universitätsklinikum der Ludwig-Maximilians-Universität München
› Author Affiliations
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Publication History

Publication Date:
20 December 2011 (online)

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Zusammenfassung

Die Therapie von neuroendokrinen Tumoren (NET) mit radioaktiv markierten Somatostatinanaloga, am häufigsten werden 177Lu-DOTATATE oder 90Y-DOTATOC verwendet, findet zunehmend Verbreitung. Rationale dieser Therapie ist die Überexpression von Somatostatinrezeptoren bei NET, die ein vorteilhaftes Tumor-zu-Hintergrund-Verhältnis erlaubt. Bei ca. 20–46% aller Patienten kann ein Therapieansprechen im Sinne einer Größenreduktion der Tumoren bei hohen Tumorstabilisierungsraten erreicht werden. Ein medianes progressionsfreies Überleben von bis zu 40 Monaten ist dokumentiert. Bei funktionell aktiven NET werden hohe Raten an Symptomkontrolle erreicht. Eine signifikante Verbesserung der Lebensqualität der therapierten Patienten, sogar bei Patienten ohne morphologisches Ansprechen, wird erzielt. Akut treten Übelkeit und Erbrechen sowie eine transiente Hämatotoxizität als Nebenwirkungen auf. Relevante, dauerhafte Nebenwirkungen wie eine Niereninsuffizienz oder ein myelodysplatisches Syndrom sind bei einer adäquaten Durchführung der Therapie unter Nephroprotektion hingegen selten. Bei mindestens gleichwertigen Ansprechraten bei jedoch deutlich geringerer Nephrotoxizität von 177Lu-DOTATATE im Vergleich zu 90Y-DOTATOC ist diesem Radiopharmakon tendenziell der Vorzug zu geben.

Abstract

Therapy of neuroendocrine tumors (NET) using radiolabelled somatostatin receptors such as 177-Lu-DOTATATE or 90Y-DOTATOC is gaining more and more importance. Due to the over expression of somatostatin receptors in NET the tumor-to-background ratio is very favourable. A significant therapy response is achievable between 20% and up to 46% of treated patients with a median time to progression of up to 40 months. Furthermore, this kind of therapy is very beneficial in the case of hormonal active, functional NET in terms of symptom control. Also quality of life is significantly improved after therapy, even in non-responding patients. The most common side effects of this therapy are nausea, vomiting and transient hematologic toxicity. However, late serious side effects such as renal impairment or myelodysplastic syndrome are rare if renal protection is used during the course of therapy.

Schlüsselwörter

neuroendokrine Tumoren - 177-Lutetium - 90-Yttrium - Radionuklidtherapie - Somatostatinrezeptor

Key words

neuroendocrine tumors - 177-Lutetium - 90-Yttrium - radionuclide therapy - somatostatin receptor
 

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