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Individualisierte regionale und systemische 5-FU-Chemotherapie durch PET und MRS-Monitoring

Individualization of regional and systemic 5-FU chemotherapy by means of PET and MRS monitoring

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Zusammenfassung

Die Positronen-Emissions-Tomographie (PET) und Magnetische Resonanzspektroskopie (MRS) eröffnen Einblicke in den Tumorstoffwechsel. Die PET erlaubt die quantitative Bestimmung der Perfusion von Gewebearealen und ist in der Lage, Aussagen über die Akkumulation von Zytostatika in Tumoren zu machen. Demgegenüber kann die MRS Stoffwechselprodukte in Tumoren nachweisen und erlaubt Aussagen über den zugrundeliegenden Metabolismus. Dies kann bei Verwendung von 5-Fluorouracil (5-FU) sowohl in vivo am Patienten unter Chemotherapie geschehen, als auch an Metastasenexzidaten. In letztem Fall können auch einzelne Intermediärprodukte des Stoffwechsels quantifiziert werden, was die Bestimmung des Anteils zytotoxischer Anabolite im Tumorgewebe erlaubt. Die31Phosphor-Spektroskopie kann zusätzlich zur Beurteilung des durch Chemotherapie induzierten Zellschadens beitragen, indem die intratumoralen Anteile energiereicher Phosphate sowie der intratumorale pH-Wert bestimmt werden.

Alle Verfahren bieten Ansätze, die Patienten herauszufinden, bei denen günstige Voraussetzung für eine effektive 5-FU-Chemotherapie bestehen, und andererseits die Patienten zu ermitteln, bei denen mit einem Ansprechen auf die Behandlung nicht gerechnet werden kann.

Summary

Recently established methods as Positron-Emission-Tomography (PET) and Magnetic Resonance Spectroscopy (MRS) enable new approaches to investigate tumor metabolism. PET allows to determine vascular perfusion of tumorous areas and an assessment on a quantitative basis. Furthermore, the accumulation of cytostatic drugs within areas of tumor may be measured in comparison to surrounding tissue using18Fluorouracil. MRS with19F provides information on the concentration of intermediate products of tumor metabolism. Assessing 5-FU metabolism, this may be used duringthe application of chemotherapy or, in an exvivo situation to examine tumor tissue samples. In this case the concentration of single metabolites of 5-FU metabolism, f.e. anabolites might be measured if their concentration exceeds 5 nmol/g tissue. With the measurement of energy-rich phosphates and the pH-value within tumors31P-MRS additionally might allow to estimate the extent of cytotoxic damage induced by chemotherapy.

PET and MRS offer new approaches to select those patients with a good chance to benefit from 5-FU chemotherapy and to rule out those in whom response to treatment might not really be expected.

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Authors and Affiliations

  1. Sektion Chirurgische Onkologie des Deutschen Krebsforschungszentrums, Heidelberg, Deutschland

    P. Schlag

  2. Chirurgischen Universitätsklinik des Deutschen Krebsforschungszentrums, Neuenheimer Feld 110, D-6900, Heidelberg 1, Deutschland

    P. Hohenberger

  3. Abteilung Radiologie und Pathophysiologie, des Deutschen Krebsforschungszentrums, Neuenheimer Feld 110, D-6900, Heidelberg 1, Deutschland

    W. Semmler & L. G. Strauß

  4. Zentralen Einheit Spektroskopie des Deutschen Krebsforschungszentrums, Neuenheimer Feld 110, D-6900, Heidelberg 1, Deutschland

    W. E. Hull

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  1. P. Hohenberger
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  4. L. G. Strauß
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  5. W. E. Hull
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Hohenberger, P., Schlag, P., Semmler, W. et al. Individualisierte regionale und systemische 5-FU-Chemotherapie durch PET und MRS-Monitoring. Acta Chir Austriaca 23, 196–209 (1991). https://doi.org/10.1007/BF02663225

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  • DOI: https://doi.org/10.1007/BF02663225

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