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Neuroendokrine Tumoren

Moderne nuklearmedizinische Optionen

  • CME_Topic_Neuroendokrine Tumoren
  • Published:
best practice onkologie Aims and scope

Zusammefassung

Für neuroendokrine Neoplasien (NEN) stehen aufgrund ihrer Expression von Somatostatinrezeptoren für die Diagnostik SPECT- oder PET-Radiopharmaka (Ga-68-markierte Peptide) zur Verfügung. Für die Therapie kommen Lu-177- oder Y-90-markierte Peptide zum Einsatz. Die Peptidrezeptor-Radionuklidtherapie (PRRT) kommt typischerweise bei G1/G2-NEN (Ki-67 < 20 %) im metastasierten und damit inoperablen Stadium nach oder alternierend zu Sandostatin zum Einsatz. Während es für pankreatische NEN chemotherapeutische Therapieoptionen vor einer PRRT gibt, kommt bei extrapankreatischen NEN bevorzugt eine PRRT zur Anwendung. Eine PRRT ist meist nebenwirkungsarm, insbesondere bei Verwendung Lu-177-markierter Peptide. Allerdings sind hämatotoxische und nephrotoxische Nebenwirkungen möglich. Karzinoidkrisen oder myelodysplastische Syndrome sind selten (< 1–2 %). Meist sind mit einer PRRT partielle Remissionen (ca. 40 %) oder eine Krankheitsstabilisierung (ca. 35 %) mit medianen Überlebenszeiten von 46–59 Monaten zu erreichen. Bei prognosebestimmender Lebermetastasierung steht eine selektive interne Radionuklidtherapie (SIRT) mit Y-90-markierten Mikrosphären zur Verfügung.

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Literatur

  1. Akerström G, Falconi M, Kianmanesh R et al (2009) ENETS consensus guidelines for the standards of care in neuroendocrine tumors: pre- and perioperative therapy in patients with neuroendocrine tumors. Neuroendocrinology 90: 203–208

    Article  PubMed  Google Scholar 

  2. Arnold R, Chen YJ, Costa F et al (2009) ENETS consensus guidelines for the standards of care in neuroendocrine tumors: follow — up and documentation. Neuroendocrinology 90: 227–233

    Article  CAS  PubMed  Google Scholar 

  3. Auernhammer CJ, Göke B (2011) Therapeutic strategies for advanced neuroendocrine carcinomas of jejunum/ileum and pancreatic origin. Gut 60: 1009–1021

    Article  CAS  PubMed  Google Scholar 

  4. Baum RP, Rösch F (Hrsg) (2013) Theranostics, Gallium-68, and other radionuclides. A way to personalized diagnosis and treatment. Springer, Berlin Heidelberg New York (Recent results in cancer research, Bd 194)

  5. Begum N, Maasberg S, Plöckinger U et al (2012) Neuroendocrine tumours of the GI Tract — Data from the German NET Registry. Zentralbl Chir (Epub ahead of print)

    Google Scholar 

  6. Bosman et al (2010) WHO classification of digestive system. IARC, Lyon

    Google Scholar 

  7. Caplin M, Sundin A, Nillson O et al (2012) ENETS consensus guidelines for the management of patients with digestive neuroendocrine neoplasms: colorectal neuroendocrine neoplasms. Neuroendocrinology 95: 88–97

    Article  CAS  PubMed  Google Scholar 

  8. Coldwell D et al (2008) Integrating radioembolisation into current treatment options for liver tumours: an International Working Group Report. World Conference on Interventional Oncology and Best of ASCO Abs. P79

    Google Scholar 

  9. Delle Fave G, Kwekkeboom DJ, Van Cutsem E et al (2012) ENETS consensus guidelines for the management of patients with gastroduodenal neoplasms. Neuroendocrinology 95: 74–87

    Article  CAS  PubMed  Google Scholar 

  10. Edge SB, Bryd DR, Compton CC et al (2010) AJCC Cancer Staging Manual. Springer, Berlin Heidelberg New York

    Google Scholar 

  11. Eriksson B, Annibale B, Bajetta et al (2009) ENETS consensus guidelines for the standards of care in neuroendocrine tumors: chemotherapy in patients with neuroendocrine tumors. Neuroendocrinology 90: 214–219

    Article  CAS  PubMed  Google Scholar 

  12. Ezziddin S, Opitz M, Attassi M et al (2011) Impact of the Ki-67 proliferation index on response to peptide receptor radionuclide therapy. Eur J Nucl Med Mol Imaging 38: 459–466

    Article  CAS  PubMed  Google Scholar 

  13. Falconi M, Bartsch DK, Eriksson B et al (2012) ENETS consensus guidelines for the management of patients with digestive neuroendocrine neoplasms of the digestive system: well-differentiated pancreatic non-functioning tumors. Neuroendocrinology 95: 120–134

    Article  CAS  PubMed  Google Scholar 

  14. IAEA (2013) Practical guidance on peptide receptor radionuclide therapy (PRRNT) for neuroendocrine tumours. Human Health Series no. 12. http://www.iaea.org/Publications/

    Google Scholar 

  15. Kennedy AS, Dezarn WA, McNeillie P et al (2008) Radioembolization for unresectable neuroendocrine hepatic metastases using resin 90Y-microspheres: early results in 148 patients. Am J Clin Oncol 31: 271–279

    Article  PubMed  Google Scholar 

  16. Klöppel G, Couvelard A, Perren A et al (2009) ENETS consensus guidelines for the standards of care in neuroendocrine tumors: towards a standardized approach to the diagnosis of gastroenteropancreatic neuroendocrine tumors and their prognostic stratification. Neuroendocrinology 90: 162–166

    Article  PubMed  Google Scholar 

  17. Krenning EP, Kooij PP, Bakker WH et al (1994) Radiotherapy with a radiolabeled somatostatin analogue, [111In-DTPA-D-Phe1]-octreotide. A case history. Ann NY Acad Sci 733: 496–506

    Article  CAS  PubMed  Google Scholar 

  18. Kwekkeboom DJ, Kam BL, Essen M van et al (2010) Somatostatin-receptor-based imaging and therapy of gastroenteropancreatic neuroendocrine tumors. Endocr Relat Cancer 17: R53–R73

    Article  CAS  PubMed  Google Scholar 

  19. Kwekkeboom DJ, Herder WW de, Kam BL et al (2008) Treatment with the radiolabeled somatostatin analog [177 Lu-DOTA 0,Tyr3]octreotate: toxicity, efficacy, and survival. J Clin Oncol 26: 2124–2130

    Article  CAS  PubMed  Google Scholar 

  20. Kwekkeboom DJ, Herder WW de, Eijck CH van et al (2010) Peptide receptor radionuclide therapy in patients with gastroenteropancreatic neuroendocrine tumors. Semin Nucl Med 40: 78–88

    Article  PubMed  Google Scholar 

  21. Kwekkeboom DJ, Krenning EP, Lebtahi R et al (2009) ENETS Consensus guidelines for the standards of care in neuroendocrine tumors: peptide receptor radionuclide therapy with radiolabeled somatostatin analogs. Neuroendocrinology 90: 220–226

    Article  CAS  PubMed  Google Scholar 

  22. Kwekkeboom DJ, Krenning EP, Scheidhauer K et al (2009) ENETS consensus guidelines for the standards of care in neuroendocrine tumors: somatostatin receptor imaging with (111)In-pentetreotide. Neuroendocrinology 90: 184–189

    Article  CAS  PubMed  Google Scholar 

  23. Kwekkeboom DJ, Teunissen JJ, Bakker WH et al (2005) Radiolabeled somatostatin analog [177Lu-DOTA0,Tyr3]octreotate in patients with endocrine gastroenteropancreatic tumors. J Clin Oncol 23: 2754–2762

    Article  CAS  PubMed  Google Scholar 

  24. Lamberts SW, Lely AJ van der, Herder WW de, Hofland LJ (1996) Octreotide. N Engl J Med 334: 246–254

    Article  CAS  PubMed  Google Scholar 

  25. Modlin IM, Lye KD, Kidd M (2003) A 5-decade analysis of 13,715 carcinoid tumors. Cancer 97: 934–959

    Article  PubMed  Google Scholar 

  26. Modlin IM, Oberg K, Chung DC et al (2008) Gastroenteropancreatic neuroendocrine tumours. Lancet Oncol 9: 61–72

    Article  CAS  PubMed  Google Scholar 

  27. Nazario J, Gupta S (2010) Transarterial liver-directed therapies of neuroendocrine hepatic metastases. Semin Oncol 37: 118–126

    Article  PubMed  Google Scholar 

  28. Oberg K, Ferone D, Kaltsas G et al (2009) ENETS consensus guidelines for the standards of care in neuroendocrine tumors: biotherapy. Neuroendocrinology 90: 209–213

    Article  PubMed  Google Scholar 

  29. O’Toole D, Grossman A, Gross D et al (2009) ENETS consensus guidelines for the standards of care in neuroendocrine tumors: biochemical markers. Neuroendocrinology 90: 194–202

    Article  PubMed  Google Scholar 

  30. Pape UF, Perren A, Niederle B et al (2012) ENETS consensus guidelines for the management of patients with neuroendocrine neoplasms from the jejuno-ileum and the appendix including goblet cell carcinomas. Neuroendocrinology 95: 135–156

    Article  CAS  PubMed  Google Scholar 

  31. Pavel M, Baudin E, Couvelard A et al (2012) ENETS consensus guidelines for the management of patients with liver and other distant metastases from neuroendocrine neoplasms of foregut, midgut, hindgut, and unknown primary. Neuroendocrinology 95: 157–176

    Article  CAS  PubMed  Google Scholar 

  32. Plöckinger U, Gustafsson B, Ivan D et al (2009) ENETS consensus guidelines for the standards of care in neuroendocrine tumors: echocardiography. Neuroendocrinology 90: 190–193

    Article  PubMed  Google Scholar 

  33. Raymond E, Dahan L, Raoul JL et al (2011) Sunitinib malate for the treatment of pancreatic neuroendocrine tumors. N Engl J Med 364: 501–513

    Article  CAS  PubMed  Google Scholar 

  34. Rindi G, Klöppel G, Couvelard A et al (2007) TNM staging of midgut and hindgut (neuro) endocrine tumors: a consensus proposal including a grading system. Virchows Arch 451: 757–762

    Article  CAS  PubMed  Google Scholar 

  35. Rinke A, Müller HH, Schade-Brittinger C et al (2009) Placebo-controlled, double-blind, prospective, randomized study on the effect of octreotide LAR in the control of tumor growth in patients with metastatic neuroendocrine midgut tumors: a report from the PROMID Study Group. J Clin Oncol 27: 4656–4663

    Article  CAS  PubMed  Google Scholar 

  36. Salazar R, Wiedenmann B, Rindi G, Ruszniewski P (2012) ENETS 2011 consensus guidelines for the management of patients with digestive neuroendocrine tumors: an update. Neuroendocrinology 95: 71–73

    Article  CAS  PubMed  Google Scholar 

  37. Sundin A, Vullierme MP, Kaltsas G et al (2009) ENETS consensus guidelines for the standards of care in neuroendocrine tumors: radiological examinations. Neuroendocrinology 90: 167–183

    Article  CAS  PubMed  Google Scholar 

  38. Yao JC, Shah MH, Ito T et al (2011) Everolimus for advanced pancreatic neuroendocrine tumors. N Engl J Med 364: 514–523

    Article  CAS  PubMed  Google Scholar 

  39. Zaknun JJ, Bodei L, Mueller-Brand J et al (2013) The joint IAEA, EANM, and SNMMI practical guidance on peptide receptor radionuclide therapy (PRRNT) in neuroendocrine tumours. Eur J Nucl Med Mol Imaging 40: 800–816

    Article  CAS  PubMed Central  PubMed  Google Scholar 

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Authors and Affiliations

  1. Klinik und Poliklinik für Nuklearmedizin, Universitätsklinikum Köln Kerpener, Str. 62, 50937, Köln, Deutschland

    M. Schmidt & A. Drzezga

  2. Klinik I für Innere Medizin - Onkologie, Hämatologie, Universitätsklinikum Köln, Köln, Deutschland

    B. Cremer

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  1. M. Schmidt
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  2. B. Cremer
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  3. A. Drzezga
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Correspondence to M. Schmidt.

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Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren

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Schmidt, M., Cremer, B. & Drzezga, A. Neuroendokrine Tumoren. best practice onkologie 9, 36–46 (2014). https://doi.org/10.1007/s11654-013-0113-6

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