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神经内分泌肿瘤(neuroendocrine neoplasm,NEN)是一类起源于神经内分泌细胞的异质性肿瘤,可以发生于任何部位,但以胃肠胰神经内分泌肿瘤(gastroenteropancreatic neuroendocrine neoplasm,GEP-NEN)最常见,好发部位依次为胰腺、直肠和胃,小肠少见,根据2019年世界卫生组织(WHO)发布的消化系统NEN分类和分级标准[1],其病理类型分为神经内分泌瘤(neuroendocrine tumor,NET)、神经内分泌癌(neuroendocrine carcinoma,NEC)和混合性神经内分泌-非神经内分泌肿瘤,其中NET包括G1、G2、G3 3个级别。
手术是治愈NET的唯一方法。然而,能否手术取决于肿瘤的大小、邻近组织的浸润情况以及腹部主要血管的受累情况,进展期的NET往往失去了手术的机会。肽受体放射性核素治疗(peptide receptor radionuclide therapy,PRRT)是针对不能手术、系统性治疗效果欠佳但生长抑素受体(somatostatin receptors,SSTR)过表达的NET患者的一种有效和安全的治疗方法,其可明显延长患者的无进展生存(progression free survival,PFS)期和总生存(overall survival,OS)期[2]。然而PRRT只能使少数患者达到疾病客观缓解[3],多数NET患者的病情仍会进展,治疗策略需要进一步改进。近年来,越来越多的研究报道了PRRT联合治疗的新方案。本文结合国内外相关临床研究,对NET的PRRT新策略研究进展进行综述。
神经内分泌瘤肽受体放射性核素治疗新策略的研究进展
Research progress of new peptide receptor radionuclide therapy strategies for neuroendocrine tumor
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摘要: 肽受体放射性核素治疗(PRRT)对于无法手术、系统性治疗效果欠佳但核医学显像证实生长抑素受体过表达的神经内分泌瘤(NET)患者,是一种成功的靶向治疗方法。PRRT可以延长该类患者的生存期,改善患者症状,提高患者生活质量,但治疗后完全缓解者并不多见,仍有较多的患者出现疾病进展,因此,PRRT联合治疗、基于α核素的PRRT等新方案近年来受到关注。笔者结合国内外相关临床研究,对NET的PRRT新策略的研究进展进行综述。Abstract: Peptide receptor radionuclide therapy (PRRT) is a successful targeted method for patients with neuroendocrine tumor (NET) who cannot be operated on, with no response to systemic therapy, but with somatostatin receptor overexpression confirmed by nuclear medical imaging. It can prolong survival and improve symptom control and quality of life in these patients. However, the patients with complete response are few, and there are still more patients with disease progression. So, some new approaches, including combination therapy with PRRT and α-nuclide-based PRRT, have attracted much attention recently. Here, this article reviews the research progress of the new PRRT strategies based on both domestic and foreign studies in this field.
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Key words:
- Neuroendocrine tumors /
- Radionuclide therapy /
- Targeted therapy
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