放射性核素反义治疗

放射性核素反义治疗将反义寡核苷酸阻断癌基因表达作用及放射性核素杀伤癌细胞作用结合在一起，是一项新兴的治疗技术。这项研究目前仍处于初步阶段，只有少量放射性寡核苷酸细胞毒性、动物体内药代动力学及组织学分布的报道。简要综述了目标基因的选择和反义寡核苷酸的标记、导入细胞及其毒副作用等几个放射性核素反义治疗有关的重要环节及其最新进展。     

放射性核素在关节炎治疗中的应用

放射性治疗关节炎包括全身放疗和局部治疗。全身放疗由于不良反应较大,现已很少使用。本文重点介绍放射性滑膜切除术治疗关节炎的作用原理、适应证、操作方法,以及不同核素的临床应用、疗效和减少不良反应的方法。     

放射性核素治疗的若干新动向

放射性核素治疗的若干新动向谭天秩放射性核素治疗已有约５０余年的历史，近年来已成为治疗多种疾病尤其是治疗肿瘤的重要手段。它具有导向性和介入治疗等特点，病变组织和正常组织之间放射性差异很明显，全身反应和并发症的发生较少或较轻，与化疗和外照射治疗相比有其独...     

放射性核素反义治疗

放射性核素反义治疗将反义寡核苷酸阻断癌基因表达作用及放射性核素杀伤癌细胞作用结合在一起,是一项新兴的治疗技术。这项研究目前仍处于初步阶段,只有少量放射性寡核苷酸细胞毒性、动物体内药代动力学及组织学分布的报道。简要综述了目标基因的选择和反义寡核苷酸的标记、导入细胞及其毒副作用等几个放射性核素反义治疗有关的重要环节及其最新进展。     

在ECT显像检查时放射性核素的注射方法及注意问题

核医学作为一门专业学科，在现代医学中有着重要的地位和作用，而在核医学工作中占据相当比重的是显像和非显像的体内检查法，以及一些放射性核素治疗等，其首要过程就是要将放射性核素及其标记化合物通过一定途经引入人体，如口服、吸入或注射等，注射是所有这些手段中最生要的一种，由于涉及到放射性核素的应用，固有其特殊性，其     

骨转移瘤的放射性核素治疗

肿瘤骨转移性骨痛可由肿瘤浸润，并且蔓延至神经支配丰富的骨膜所致；也可由肿瘤的机械性压迫导致骨组织变薄所致；还可因肿瘤从骨组织扩散至神经组织所致。本介绍放射性核素治疗骨痛的方法、疗效和毒副作用。展望未来１０年，使用放射性核素治疗骨转移疼痛患将趋于更普遍。     

甲亢与优生

甲亢是甲状腺激素分泌过多而引起的一种高代谢状态,多发于20～30岁的育龄女性。女性患甲亢后,常伴有月经紊乱、排卵减少甚至闭经,这些都会使受孕出现困难。早期或轻症的甲亢患者以及经过抗甲状腺药物治疗的患者即使有受孕的可能,但由于其体内的甲状腺激素可以通过胎盘直接影响胎儿的甲状腺功能,所以新生儿中患甲亢的概率也是比较高的。甲亢患者怀孕之后也很容易发生流产、早产、妊娠中毒症、死胎。另外,甲亢患者妊娠还会加重心脏的负担,容易诱发心脏病。因此,甲亢患者在病情没有完全控制时是不宜生育的。患有甲亢的妇女如果想怀孕,可以选择…     

骨转移癌的放射性核素治疗

目的:探讨核素内照射控制骨转移癌引起骨痛的作用。方法:骨转移癌患者117例,均经病理证实为恶性肿瘤,其中前列腺癌55例、肺癌39例、乳腺癌8例、结肠癌8例、胃癌2例、鼻咽癌2例、宫颈癌1例、肾癌1例、淋巴瘤1例。显像示有一处以上骨转移灶。静脉注射89Sr,剂量为4 mCi/人。结果:疼痛缓解的总有效率为71.8%(84/117),其中显效率和部分有效率分别为31.6%(37/117)、40.2%(47/117),无效率为28.2%(10/35)。来源于前列腺癌和乳腺癌的骨转移癌疼痛控制有效率达79.4%(50/63)。98例复查骨显像的患者,81例骨转移灶代谢减低、缩小或消失,占82.7%;16例原有病灶部分消失、缩小,放射性摄取减低,但有新病灶出现,占16.3%;1例较治疗前加重,占1.0%。结论:在确诊骨转移癌的病人中掌握好核素内照射治疗适应证,并与其他疗法配合可获得良好的疗效。     

靶性放射性核素治疗骨转移

靶性放射性核素治疗恶性肿瘤骨转移，可以缓解转移性骨痛，改善患生存质量。本在综述各种转移性骨痛治疗方法的同时，重点论述了＾８９Ｓｒ、＾１６３Ｓｍ、＾１８６Ｒｅ及其放化药物的研究及临床应用。     

核素示踪靶向肿瘤新生血管分子探针的研究进展

肿瘤是一种严重危害人类健康和生命的疾病,它的早期诊断和早期治疗可以明显延长患者的生存时间和提高患者的生活质量。目前,肿瘤靶向诊断和靶向治疗成为研究热点。靶向肿瘤新生血管的多肽精氨酸-精氨酸-亮氨酸（RRL）序列能够特异性靶向结合于肿瘤来源内皮细胞,国内学者证实了131I-RRL对肿瘤细胞的杀伤作用,以及99Tcm-RRL在不同肿瘤模型中的SPECT显像效果。国外学者已经将靶向肿瘤新生血管的小分子多肽精氨酸-甘氨酸-天冬氨酸用于临床前期阶段。     

Recent advances in radionuclide therapy

A variety of radionuclides continue to be investigated and/or clinically used for different therapeutic applications in nuclear medicine. The choice of a particular radionuclide with regard to appropriate emissions, linear energy transfer, and physical half-life is dictated to a large extent by the character of the disease (eg, solid tumor or metastatic disease) and by the carrier used to selectively transport the radionuclide to the desired site. An impressive body of information has appeared in the recent literature that addresses many of these considerations. This article summarizes and discusses the many recent advances and the progress in the clinical applications of therapeutic radionuclides in relatively new and developing areas, such as radioimmunotherapy, peptide therapy, intravascular therapy to prevent restenosis, radiation synovectomy, and bone malignancy therapy. Projections are made as to the future directions and progress in these areas. The crucial issue of a reliable, year-round supply of new and emerging therapeutic radionuclides in quantities sufficient initially for research, and then for routine clinical use, is a very worthy goal which, in the United States, remains to be achieved.     

Recent progress in radionuclide therapy

Therapeutic use of radionuclides includes 131I for thyroid cancer and hyperthyroid Graves' disease, 89SrCl3 for metastatic bone tumors, 131I-MIBG for malignant pheochromocytoma and neuroblastoma, and radioimmunotherapies. 131I is concentrated in 60-70% of metastases from differentiated thyroid cancer following total thyroidectomy. Radioiodine uptake in metastatic lesions is greater in younger patients than in older ones. Hypothyroidism is often mild or even absent in patients with a large amount of tumor tissue, indicating that thyroid hormones produced by highly differentiated tumors compensate partially or even completely for hypothyroidism following total thyroidectomy. Adequate uptake of 131I has been reported to be associated with significant reduction in the size and number of metastases, and with lower recurrence and higher survival rates. Other favorable factors for longer survival are younger age, well-differentiated histological type, small disease extent, and early discovery of metastases. Older patients with extensive metastases and/or bulky tumor masses in the bone have a poor prognosis. Therefore, it is important to discover metastases as early as possible, when patients are still young. Long-term follow-up with periodic thyroglobulin measurements and imaging studies is strongly recommended. In Japan, 131I treatment for Graves' disease is performed only in selected patients in whom antithyroid drugs cannot be used because of side effects or not effective, considering the high prevalence of permanent hypothyroidism. 89SrCl3 is useful for reducing pain due to bone metastases of malignant tumors. 131I-MIBG therapy is effective for improvement of QOL in some patients with metastatic malignant pheochromocytoma. Radioimmuno-therapy using anti-CD20 has been used successfully in clinical application in patients with malignant B cell lymphoma.     

Depression and anxiety during isolation and radionuclide therapy

The combination of a diagnosis of malignancy and hospitalization, isolation and radioactivity of a radionuclide therapy may have an important effect on the psychological equilibrium of patients and may hamper compliance and acceptability. We performed a psychiatric evaluation in order to study psycho-pathological manifestations and underlying personality related vulnerabilities. During radioisolation, 48 patients (24 male, 24 female; mean age 57.8 years) with a malignant (n=26) or non-malignant (n=22) pathology who needed isolation for radionuclide therapy, completed a series of questionnaires in order to assess anxiety (Spielberger State and Trait Anxiety Inventory; STAI), depression (Beck Depression Inventory; BDI), hopelessness (Beck Hopelessness Scale; BHS), personality characteristics (Temperament and Character Inventory; TCI) and coping strategies (Utrecht's Coping List; UCL). Compared to patients with low state anxiety, patients who experienced a high level of state anxiety showed higher levels of depression (t=-2.10; P=0.04) and hopelessness (t=-4.20; P=<0.001). Their personality was characterized by significantly higher scores on harm avoidance (t=-2.78; P=0.008) and lower scores on self-directedness (t=3.12; P=0.003). Coping strategies were more passive (t=-2.43; P=0.02), avoiding (t=-2.15; P=0.04) and less well aimed (t=2.64; P=0.01). Surprisingly, the nature of disease (malignant versus non-malignant) did not influence these results, nor was there a difference between males and females, age, years of education, having a relationship or not, or the duration of hospitalization. Thus, contrary to what may be expected in isolation with radionuclide therapy, subgroups such as women, elderly, cancer patients or lower educated people do not, a priori, exhibit a higher state anxiety level. Our study shows these levels to be closely related to individual personality traits and coping strategies that are inadequate for the situation. Screening for trait anxiety before admission can be easily done and may guide interventions aimed at increasing patient comfort and acceptability.     

Targeted radionuclide therapy for bone metastases

Recent advances in targeted radiotherapy offer a new approach for the management of metastatic bone pain. This paper will review the scientific basis for radionuclide therapy and will examine the evidence for clinical efficacy. The therapeutic potential of targeted radiotherapy can only be appreciated by comparison with established treatments. Alternative treatment options will, therefore, be discussed, to bring the potential advantages and hazards of targeted radiotherapy into perspective and to define its place in routine management.     

放射性核素治疗的策略问题

1核素治疗的现状自1942年Hamlton报告用131I治疗甲状腺疾病以来,通过半个多世纪的努力,近年来核素治疗有了较快的发展,然而与核素显像相比存在较大差距,其表现为:(1)接受治疗人数明显低于显像。据上海市核医学质控中心统计,1999年上海接受核素治疗为6000例,占核医学诊治人数的12%。2002年中华医学会核医学分会统计,全国接受核素治疗为16万人次,占核医学诊治人数的24.2%;(2)治疗项目少,应用范围窄。     

肿瘤核素靶向治疗新进展

利用靶向分子将放射性核素定向导入肿瘤组织实现核素靶向治疗是肿瘤治疗的重要方法。利用单克隆抗体或小分子肽携带治疗性放射性核素,分别与肿瘤细胞表面表达丰富的抗原或受体特异性结合而开展放射免疫治疗或受体介导的核素治疗是靶向治疗的主要策略。近年来,这两种靶向治疗取得较大进展,部分已进入临床应用。随着靶向分子的不断出现、分子靶向技术的不断完善,肿瘤核素靶向治疗终将成为肿瘤治疗的重要方法。     

Horizons in radionuclide therapy: 1985 update

In 1981, I made the strong statement that "The therapeutic approach of internally administered radiopharmaceuticals offers the potential to outmode the present approaches of conventional radiation therapy and chemotherapy." The present article updates and further supports this statement with new data, especially with the use of [131I]MIBG in several cancers and proposes a plan for application of nonsealed source radionuclide therapy to most solid tumors.