小肠或胰腺来源的进展期胃肠胰腺神经内分泌癌的治疗策略

2011-06-13 姚尧 李景南 医学论坛报

 英国《消化道》(Gut)杂志近期在线发表了德国学者的一篇综述。该综述回顾了有关空/回肠或胰腺来源的进展期胃肠胰腺神经内分泌癌(NEC)的治疗方案。   外科手术   外科手术仍然是NEC唯一的治愈方法。对于分化良好的NEC,肝转移灶的手术切除和切除90%以上的减容手术可能可以改善总体预后。因此,对于分化良好的NEC,无论是局部病灶,还是已有远处肝转移,都推荐进行外科手术治疗,即使存在肝转移,

 英国《消化道》(Gut)杂志近期在线发表了德国学者的一篇综述。该综述回顾了有关空/回肠或胰腺来源的进展期胃肠胰腺神经内分泌癌(NEC)的治疗方案。

  外科手术

  外科手术仍然是NEC唯一的治愈方法。对于分化良好的NEC,肝转移灶的手术切除和切除90%以上的减容手术可能可以改善总体预后。因此,对于分化良好的NEC,无论是局部病灶,还是已有远处肝转移,都推荐进行外科手术治疗,即使存在肝转移,原发灶切除也可使NEC(尤其是空/回肠)患者获益。

  消融治疗

  同位素90 钇(Y)微粒体选择性内照射是治疗弥漫性肝转移的新方法,疗效相当于肝动脉栓塞术(TAE)或肝动脉化疗栓塞术(TACE)的重复循环治疗。这些消融方法都被推荐用于不能手术的肝转移患者。

  肽受体放射性核素治疗

  目前,对于存在远处转移的NEC,可采用一些同位素标记的生长抑素类似物[如90Y-DOTA-TOC、90Y-DOTA-TATE、177镥(Lu)-DOTA-TATE]进行肽受体放射性核素治疗(PRRT)。对于伴或不伴肝内肿瘤的不能手术的肝外肿瘤患者,无论生长抑素受体是否有足够的表达,都似乎是PRRT的指征。

  生物治疗及化疗

  生长抑素类似物(长效奥曲肽)是控制功能活跃NEC症状的重要药物,可用于空/回肠分化良好的功能性或非功能性NEC的抗肿瘤细胞增殖治疗。

  替莫唑胺+卡培他滨是治疗胰腺NEC的新型化疗方案。链佐霉素为基础的方案仍是分化良好的胰腺NEC的推荐化疗方案。以奥沙利铂为基础的方案有望用于二线治疗。

  靶向治疗

  在Ⅲ期试验中,新型靶向治疗药物依维莫司或舒尼替尼均可延长胰腺NEC患者的无疾病进展生存期。去年,欧洲药品管理局批准胰腺NEC作为舒尼替尼的适应证。依维莫司也将在未来获得批准。

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    2011-07-04 gwc392
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