{"id":9689,"date":"2020-11-14T13:09:05","date_gmt":"2020-11-14T18:09:05","guid":{"rendered":"https:\/\/cornflowerblue-rail-980953.hostingersite.com\/?p=9689"},"modified":"2020-11-15T01:09:07","modified_gmt":"2020-11-15T06:09:07","slug":"whats-new-in-nuclear-medicine-turkish-november-2020","status":"publish","type":"post","link":"https:\/\/staging-hub.acoredu.com\/tr\/whats-new-in-nuclear-medicine-turkish-november-2020\/","title":{"rendered":"What’s new in Nuclear Medicine (Turkish) – November 2020"},"content":{"rendered":"
Tiroglobulin y\u00fcksek iyot sintigrafisi negatif olgularda, Lu-177 DOTATATE peptit resept\u00f6r radyon\u00fcklid tedavisinin klinik etkinli\u011fi: GEP-NET’lere g\u00f6re “o kadar da umut verici olmayan” bir sonu\u00e7<\/strong><\/span><\/h5>\n

Basu, S.; Parghane, R. V.; Naik, C.<\/p>\n

D\u00fcnya J Nucl\u00a0 Med 2020; 19: 205-10.<\/p>\n

Giri\u015f:<\/strong><\/p>\n

Lu-177 DOTATATE, somatostatin resept\u00f6rlerini (SSTR) eksprese eden gastroenteropankreatik (GEP) n\u00f6roendokrin t\u00fcm\u00f6rlerin (NET’ler) tedavisi i\u00e7in yayg\u0131n olarak onaylanan radyo-etiketli bir somatostatin analo\u011fudur. Bu ba\u011flamda \u00f6nemli bir etkinlik g\u00f6stermi\u015f olup DOTATATE-avid hastal\u0131\u011f\u0131 olan dediferansiye tiroid karsinomlar\u0131nda da faydal\u0131 olabilece\u011fi hipotezi \u00f6ne s\u00fcr\u00fclm\u00fc\u015ft\u00fcr.<\/p>\n

Ama\u00e7:<\/strong><\/p>\n

Yazarlar y\u00fcksek tiroglobulin d\u00fczeyleri ve negatif iyot sintigrafisi (tiroglobulin-y\u00fcksek negatif iyot sintigrafisi, TENIS) ile ili\u015fkili tiroid karsinomlar\u0131n\u0131n tedavisinde Lu-177 DOTATATE’nin etkisini de\u011ferlendirmeye \u00e7al\u0131\u015f\u0131rlar.<\/p>\n

Y\u00f6ntemler:<\/strong><\/p>\n

Metastatik TENIS i\u00e7in Lu-177 DOTATE alan hastalar\u0131n retrospektif incelemesi yap\u0131ld\u0131. T\u00fcm hastalar\u0131n SSTR pozitifli\u011fini belirlemek i\u00e7in ilk g\u00f6r\u00fcnt\u00fclemesi ve en az bir Lu-177 DOTATATE tedavisi d\u00f6ng\u00fcs\u00fc tamamland\u0131. D\u0131\u015flama kriteri yoktu.<\/p>\n

Lezyonlar, ilk g\u00f6r\u00fcnt\u00fcleme taramas\u0131nda kalitatif radyo-izleyici al\u0131m\u0131na g\u00f6re karakterize edildi ve hastalar hi\u00e7 al\u0131m olmayan (Grade 0), karaci\u011ferden daha az al\u0131m (Grade I), karaci\u011fere e\u015fit al\u0131m (Grade II) ve karaci\u011ferden daha \u00e7ok al\u0131m (Grade III) \u015feklinde s\u0131n\u0131fland\u0131. Toplanan bilgiler aras\u0131nda hasta demografisi, metastatik y\u00fck, Lu-177 DOTATE tedavisinin \u00f6zellikleri, klinik yan\u0131t ve \u00f6nemli hematolojik veya renal toksisite varl\u0131\u011f\u0131 yer alm\u0131\u015ft\u0131r. Tedaviye klinik yan\u0131t, semptomlar\u0131n her birinde “tam yan\u0131t” (CR), “k\u0131smi yan\u0131t” (PR), “stabil hastal\u0131k” (SD) veya “progresif hastal\u0131k” (PD) olarak de\u011ferlendirildi, serum timoglobulin (TG) d\u00fczeyi ve Solid T\u00fcm\u00f6rlerde PET Yan\u0131t De\u011ferlendirme Kriterleri (PERCIST) ile PET\/BT g\u00f6r\u00fcnt\u00fclemesi yap\u0131ld\u0131. CR\u00a0 semptomlar\u0131n kaybolmas\u0131 veya TG’de %>%75 azalma olarak tan\u0131mland\u0131; PR semptomlarda %30-75 azalma veya TG’de %30-75 azalma; SD oldu <30% belirti azaltma veya <30% TG de\u011fi\u015fim; PD semptomlarda veya yeni semptomlarda %30 art\u0131\u015f veya TG’de %30 \u00a0art\u0131\u015f olarak kabul edildi.<\/p>\n

Sonu\u00e7lar:<\/strong><\/p>\n

Sekiz hasta dahil edildi: \u00fc\u00e7\u00fc bir Lu-177 DOTATE tedavisi d\u00f6ng\u00fcs\u00fcn\u00fc, ikisi iki d\u00f6ng\u00fcy\u00fc, biri \u00fc\u00e7 d\u00f6ng\u00fcy\u00fc ve ikisi d\u00f6rt d\u00f6ng\u00fcy\u00fc tamamlam\u0131\u015ft\u0131. Maligniteler aras\u0131nda d\u00f6rt papiller karsinom vakas\u0131, iki follik\u00fcler varyant papiller karsinom, bir k\u00f6t\u00fc diferansiye karsinom ve bir folik\u00fcler karsinom mevcuttu ve hepsinde metastaz vard\u0131. Hastalar\u0131n \u00e7o\u011funda (6) ilk SSTR g\u00f6r\u00fcnt\u00fclemede Derece II tutulum vard\u0131. Hi\u00e7birinde \u00f6nemli hematolojik veya renal toksisite bulgusu yoktu.<\/p>\n

D\u00f6rt hasta semptomlara g\u00f6re PD sergiledi; \u00fc\u00e7\u00fcnde semptomlarda PR ve birinde CR semptomlar\u0131 vard\u0131. Be\u015f hastada artm\u0131\u015f TG (PD) vard\u0131; \u00fc\u00e7\u00fcnde TG (PR) azalma vard\u0131. \u0130lerlemeden 7-16 ay sonra alt\u0131 hastada PD ve ikisinde g\u00f6r\u00fcnt\u00fcleme ile SD vard\u0131.<\/p>\n

Tart\u0131\u015fma:<\/strong><\/p>\n

TENIS i\u00e7in SSTR tedavisinin etkinli\u011fi \u00fczerine var olan literat\u00fcr s\u0131n\u0131rl\u0131d\u0131r: Budiawan\u00a0 ve ark. 2\/16 hastada PR, 4\/16’da SD ve 5\/16’da PH saptanm\u0131\u015ft\u0131r; Versari\u00a0 ve ark. 2\/11 PR, 5\/11 SD ve 4\/11 PD saptad\u0131;\u00a0 CzepczyNski ve ark. g\u00f6r\u00fcnt\u00fcleme ve TG ile 1\/6 PR, g\u00f6r\u00fcnt\u00fcleme ve TG ile 2\/6 SD ve TG ile 4\/6 SD, ve TG ile 3\/6 PD saptad\u0131. G\u00fcncel \u00e7al\u0131\u015fma benzer sonu\u00e7lar\u0131 g\u00f6stermi\u015ftir.<\/p>\n

Yazarlar, TENIS’in SSTR tedavisine nispeten k\u00f6t\u00fc yan\u0131t\u0131n\u0131n GEP-NET’lere k\u0131yasla TENIS’te SSTR’nin daha d\u00fc\u015f\u00fck derecede ifade edilmesinden kaynakland\u0131\u011f\u0131n\u0131 ve TENIS’in genellikle FDG-avid oldu\u011funu ve daha agresif bir hastal\u0131k oldu\u011funu \u00f6ne s\u00fcrmektedirler.<\/p>\n

Sonu\u00e7:<\/strong><\/p>\n

Sonu\u00e7 olarak, TENIS i\u00e7in SSTR tedavisinin etkinli\u011fi GEP-NET i\u00e7in oldu\u011fu kadar yararl\u0131 olmad\u0131\u011f\u0131 g\u00f6sterilmi\u015ftir, ancak birka\u00e7 hastada hafif bir yarar\u0131 olabilir.<\/p>\n

 <\/p>\n

Metastatik Prostat Kanseri<\/strong> Olan Hastalarda PET G\u00f6r\u00fcnt\u00fclemenin Klinik Etkisi<\/strong><\/span><\/h5>\n

Tuncel, M.;\u00a0 Tuncalt, M. C.;\u00a0 Telli, T.;\u00a0 Erman, M.<\/p>\n

Clin Nucl Med 2020; 45: 757-64.<\/p>\n

Giri\u015f:<\/strong><\/p>\n

Metastatik olmayan prostat kanseri %98.9’a kadar y\u00fcksek sa\u011f kal\u0131m oranlar\u0131na sahipken, metastatik prostat kanserinde sa\u011f kal\u0131m oranlar\u0131 %30’a d\u00fc\u015ft\u00fc. Hastal\u0131\u011f\u0131n g\u00f6r\u00fcnt\u00fcleme \u00f6zelliklerinin bilinmesi prognozun ve spesifik tedavilerin potansiyel faydalar\u0131n\u0131 belirlemeye yard\u0131mc\u0131 olur: Bu nedenle metastatik prostat kanserinde molek\u00fcler g\u00f6r\u00fcnt\u00fclemenin \u00f6nemi artmaktad\u0131r.<\/p>\n

Tart\u0131\u015fma:<\/strong><\/p>\n

PSMA, prostat kanserlerinin>% 90’\u0131nda a\u015f\u0131r\u0131 eksprese edilir ve daha y\u00fcksek dereceli kanserlerde daha fazla eksprese edilir. Ga-68 PSMA PET \/ CT g\u00f6r\u00fcnt\u00fcleme, kemik sintigrafisi, CT veya MRI gibi geleneksel g\u00f6r\u00fcnt\u00fclemeden daha hassas oldu\u011fu i\u00e7in biyokimyasal rek\u00fcrrenste (PSA> 0.2 mg \/ mL) \u00f6nerilir. McCarthy ve arkada\u015flar\u0131 taraf\u0131ndan geleneksel g\u00f6r\u00fcnt\u00fclemede hastal\u0131\u011f\u0131 olmayan 199 hastay\u0131 kapsayan bir \u00e7al\u0131\u015fmada,% 74’\u00fcnde PET \/ BT’de PSMA-avid lezyonlar oldu\u011fu bulundu; konvansiyonel g\u00f6r\u00fcnt\u00fclemede oligometastatik hastal\u0131k kan\u0131t\u0131 olan 39’un % 41’i polimetastatik olarak de\u011ferlendirildi. Yazarlar, Ga-68 PSMA PET \/ CT’nin, normal bir BT taramas\u0131 mevcutken, tek bir kemik metastaz\u0131 g\u00f6steren bir hastada lenf nodu metastazlar\u0131n\u0131 ayd\u0131nlatt\u0131\u011f\u0131 bir vaka sunmu\u015ftur: bu bilgi, g\u00f6r\u00fcnt\u00fc k\u0131lavuzlu\u011funda t\u00fcm metastazlar\u0131n tedavisine olanak tan\u0131m\u0131\u015ft\u0131r. stereotaktik v\u00fccut radyoterapisi.<\/p>\n

Prostat kanserlerinde k\u00fc\u00e7\u00fck bir oran (<%10) PSMA’y\u0131 a\u015f\u0131r\u0131 eksprese etmedi\u011fi i\u00e7in PSMA PET\/CT’yi k\u00f6t\u00fc diferansiye bu kanserleri izlemek i\u00e7in k\u00f6t\u00fc bir g\u00f6r\u00fcnt\u00fcleme se\u00e7imi haline getirmektedir. PSMA-negatif prostat kanserinde FDG PET\/CT de\u011ferini g\u00f6steren bir dizi olgu, sonraki tedavi kararlar\u0131nda rehberlik etmek i\u00e7in sunuldu.<\/p>\n

Y\u00fcksek PSMA-avid lezyonlarda radyon\u00fcklid bir tedavi se\u00e7ene\u011fi haline gelir: beta yay\u0131c\u0131 Lu-177 PSMA \u00fc\u00e7\u00fcnc\u00fc basamak tedavi olarak metastatik kastrasyona diren\u00e7li prostat kanserinde de\u011ferlendirilebilir. PSA’da azalma ve objektif remisyona yol a\u00e7abilece\u011fi g\u00f6sterilmi\u015f olmakla birlikte, Faz 3 klinik denemesi devam etmektedir . Yazarlar; ADT, Docetaxel, Abiraterone ve Cabazitaxel’i takiben rek\u00fcrrens ya\u015fayan 76 ya\u015f\u0131nda bir erkek vakas\u0131n\u0131 bildirdiler; daha sonra Ga-68 PSMA PET \/ CT ile g\u00f6r\u00fcnt\u00fclendi, PSMA-avid hastal\u0131\u011f\u0131 oldu\u011fu bulundu ve Lu-177 PSMA tedavisi ile tedavi edildi, bu da g\u00f6r\u00fcnt\u00fcleme ve PSA seviyeleri ile hastal\u0131\u011f\u0131n gerilemesine neden oldu. Yazarlar\u0131n kurumundaki hem PSMA hem de FDG avid olan ba\u015fka bir hastada g\u00f6r\u00fcnt\u00fcleme ve PSA seviyelerinde progesyon izlendi; ba\u015fta maliyet nedeniyle erteledi\u011fi Ra-223 tedavisine devam etti.<\/p>\n

Sonu\u00e7:<\/strong><\/p>\n

Yazarlar, PSMA ve FDG-PET’in prostat kanseri evreleme ve tedavisindeki rol\u00fcn\u00fc \u00f6zetleyen, merkezlerindeki temsili vakalar da dahil olmak \u00fczere resimsel bir kompozisyon sunarlar.<\/p>\n

 <\/p>\n

Prostat kanseri d\u0131\u015f\u0131ndaki malignitelerde prostata \u00f6zg\u00fc membran antijen al\u0131m\u0131na genel bak\u0131\u015f: Resimsel bir makale<\/strong><\/span><\/h5>\n

Caferi, E.; Ahmedzadehfar, H.; Dadgar, H.; Assadi, Bay.<\/p>\n

D\u00fcnya J Nucl\u00a0 Med 2020; 19:260-5.<\/p>\n

Giri\u015f:<\/strong><\/p>\n

PSMA (prostat spesifik membran antijeni) g\u00f6r\u00fcnt\u00fcleme, prostat kanserinin yay\u0131lmas\u0131n\u0131 tespit etmek i\u00e7in kullan\u0131lan bir tekniktir. Kavramsal olarak, radyofarmas\u00f6tik, \u00f6zellikle daha ilerlemi\u015f kanserlerde, PSMA glikoproteini a\u015f\u0131r\u0131 ifade eden prostat h\u00fccrelerine yerle\u015fir; PSMA PET-CT\u2019de Ga-68 ba\u015fta olmak \u00fczere gama radyasyonunun radyoizotop taraf\u0131ndan saptanmas\u0131yla lokalize edilir.<\/p>\n

Bulgular:<\/strong><\/p>\n

Son ara\u015ft\u0131rmalar, PSMA radyofarmas\u00f6tikinin lokalizasyonunun prostat kanserine \u00f6zg\u00fc olmad\u0131\u011f\u0131n\u0131, ancak di\u011fer kanserlerde de neovask\u00fclarizasyon nedeniyle ifade edildi\u011fini bulmu\u015ftur. Yazarlar, daha sonra patolojik olarak beyin, tiroid, meme, akci\u011fer, hepatik, jinekolojik ve kolorektal malignitelerde de PSMA al\u0131m\u0131n\u0131 g\u00f6steren bu vaka raporlar\u0131ndan baz\u0131lar\u0131n\u0131 \u00f6zetlediler. Daha \u00f6nce tan\u0131mlanmam\u0131\u015f PSMA-avid \u00f6zofagus kanseri, kolanjiyokarsinom ve pankreas kanseri g\u00f6r\u00fcnt\u00fclerini ortaya koydular<\/p>\n

Sonu\u00e7:<\/strong><\/p>\n

PSMA g\u00f6r\u00fcnt\u00fcleme, d\u00fczlemsel sintigrafi veya PET-BT, prostat kanseri evrelemesi i\u00e7in hassas bir ara\u00e7t\u0131r, ancak yorumlanmas\u0131 s\u0131ras\u0131nda t\u00fcm\u00f6r neovask\u00fclarizasyonundan kaynaklanan bir glikoprotein olmas\u0131 nedeniyle spesifisitesinin limitli oldu\u011fu dikkate al\u0131nmal\u0131d\u0131r.<\/p>\n

 <\/p>\n

Translated by: Mine Sorkun<\/p>\n","protected":false},"excerpt":{"rendered":"Tiroglobulin y\u00fcksek iyot sintigrafisi negatif olgularda, Lu-177 DOTATATE peptit resept\u00f6r radyon\u00fcklid tedavisinin klinik etkinli\u011fi: GEP-NET’lere […]","protected":false},"author":3,"featured_media":1985,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_bbp_topic_count":0,"_bbp_reply_count":0,"_bbp_total_topic_count":0,"_bbp_total_reply_count":0,"_bbp_voice_count":0,"_bbp_anonymous_reply_count":0,"_bbp_topic_count_hidden":0,"_bbp_reply_count_hidden":0,"_bbp_forum_subforum_count":0,"footnotes":""},"categories":[209],"tags":[],"class_list":["post-9689","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-uncategorized-tr"],"yoast_head":"\nWhat's new in Nuclear Medicine (Turkish) - November 2020 - ACORE<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/staging-hub.acoredu.com\/whats-new-in-nuclear-medicine-november-2020\/\" \/>\n<meta property=\"og:locale\" content=\"tr_TR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"What's new in Nuclear Medicine (Turkish) - 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