Nuclear medicine in the treatment of neuroendocrine tumours—problems and perspectives

Autor: Agata Białoszewska, Tomasz Grzela, Robert Brawura-Biskupski-Samaha
Rok vydání: 2006
Předmět:
Zdroj: European Journal of Nuclear Medicine and Molecular Imaging. 34:444-447
ISSN: 1619-7089
1619-7070
DOI: 10.1007/s00259-006-0300-6
Popis: Neuroendocrine tumours (NETs) constitute a large group of neoplasms originating from neuroepithelial crest-derived pluripotent stem cells or differentiated endocrine cells. NET cells and their ancestors are characterised by the ability to take up and decarboxylate the amine precursors (APUD system), the production of several bioactive peptides and the demonstration of particular histopathological staining [1]. The majority of NETs are well differentiated, displaying relatively low proliferative activity. Their ability to produce and release biologically active substances (amines and neuropeptides) results in the appearance of characteristic clinical symptoms [2]. On the other hand, some poorly differentiated and highly malignant NET display very aggressive behaviour, presumably as a result of the overexpression of various cytokines, including transforming growth factor (TGF)-α, nerve growth factor (NGF) and vascular endothelial growth factor (VEGF). Owing to the widespread distribution of APUD cells, the primary NET foci may develop in almost every organ, including gastrointestinal and respiratory tracts, pancreas, adrenal, thyroid and parathyroid glands, thymus, etc. In addition to local infiltration, NET cells form metastases in distant organs at early stages of tumour development. Thus, a radical surgical treatment, which could be curative, is unfortunately impossible [2]. Therefore, NET management requires a multidisciplinary approach that involves nuclear medicine methods as a key constituent of diagnosis, providing data reflecting the biological status of the tumour cells. These methods offer an opportunity to analyse tumour metabolism, stage of differentiation, proliferation rate, expression of various receptors and radiotracer uptake and accumulation. These crucial parameters may be further used to select the most effective form of NET therapy, e.g. surgery, chemotherapy, immunomodulation, external radiotherapy or endoradiotherapy [3]. Since endoradiotherapy is aimed at both the primary tumour and distant metastatic foci, it may be useful either early after surgery, to eliminate occult disease, or in later stages to destroy disseminated neoplasm, with radiation delivery targeting tumour cells while ensuring relative sparing of normal tissue.
Databáze: OpenAIRE
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