^90Y—DOTATATE治疗进展期神经内分泌肿瘤的临床价值

目的评价^90Y-生长抑素类似物1，4，7，10-四氮杂十二环-1，4，7，10-四乙酸-octreotate（^90Y-（DOTA）^0，Tyr^3]oetreotate，即^90Y—DOTATATE）联合使用。肾保护剂赖氨酸治疗进展期神经内分泌肿瘤的疗效以及不良反应。方法25例进展期神经内分泌肿瘤患者，经生长抑素受体（SSTR）显像（SRS）诊断为SSTR阳性肿瘤。^90Y—DOTATATE在30min内静脉滴注完毕，用药前后输注赖氨酸。每人完成1～5次治疗，间隔时间为6～9周。每次单程治疗后根据美国国立癌症研究院分级标准（NCIGC）评价不良反应。完成末次治疗后8周依据WHO标准评价疗效。结果部分缓解1例，占4％（1／25）；轻微缓解3例，占12％（3／25）；病情稳定16例，占64％（16／25）；病情进展5例，占20％（5／25）。2例出现不同程度的肾功能损害，3例出现白细胞下降，出现恶心及呕吐症状各3例。结论以赖氨酸作为肾保护剂，^90Y—DOTATATE治疗转移和不能手术的神经内分泌肿瘤是一种有效的新疗法；但应该进一步采取措施减轻肾毒性。

Treatment of advanced neuroendocrine tumors with ~(90)Y-DOTATATE

Objective To evaluate the effcacy and side effects of [~(90)Y-1,4,7,10-tetraazacyclododecane-N,N',N",N'"-tetraacetic acid (DOTA)~0,Tyr3]octreotate (~(90)Y-DOTATATE) combined with lysine as a renal protective agent.Methods Twenty-five patients with advanced neuroendocrine tumors were confirmed as somatostatin receptor subtype-2 (SSTR2)-positive by somatostatin receptor scintigraphy (SRS).Each patient received 1-5 cycles of treatment and the interval between two cycles of treatment was 6-9 weeks.~(90)Y-DOTATATE was administered intravenously within 30 min.Lysine was injected before and after the administration of ~(90)Y-DOTATATE.After each treatment cycle.the side effects were assessed according to National Cancer Institute Grading Criteria(NCIGC).The etticacy was evaluated by the WHO criteria 8 weeks after the last treatment.Results Pattial remission was found in 1 patient (4%).minor response in 3 patients(12%),stable disease in 16 patients (64%)and tumor progression in 5 patients (20%).Two patients suffered from renal functional injuries and 3 patients developed leukocytopenia.Three patients showed nausea while another 3 patients presented vomiting.Conclusions ~(90)Y-DOTATATE in association with lysine may be a promising treatment method for the patients with metastatic and inoperable neuroendocrine tumors.More research work may be directed to reduce renal injury.