National Research Tomsk Polytechnic University (Deputy Director)
Tomsk, Russian Federation
Tomsk, Russian Federation
Tomsk, Russian Federation
Tomsk, Russian Federation
Tomsk, Russian Federation
Tomsk, Russian Federation
Obsuzhdayutsya problemy diagnostiki i lecheniya neyroendokrinnyh opuholey, predstavlyayuschih soboy geterogennuyu gruppu onkologicheskih zabolevaniy s raznoobraznymi klinicheskimi proyavleniyami i biologicheskimi osobennostyami, zavisyaschih kak ot lokalizacii i rasprostranennosti opuholevogo processa, tak i ot proyavleniy gormonal'noy sekrecii. Nesmotrya na to, chto neyroendokrinnye opuholi yavlyayutsya dostatochno redkimi, v nastoyaschee vremya otmechaetsya nepreryvnyy rost zabolevaemosti. Osoboe vnimanie v dannoy rabote udelyaetsya izucheniyu roli vysokoaffinnyh somatostatinovyh receptorov (sstr), rassmatrivaemyh v kachestve osnovnyh misheney v teranostike dannoy gruppy onkologicheskoy patologii. V svyazi s nevozmozhnost'yu ispol'zovaniya nativnogo somatostatina, v nastoyaschee vremya aktivno primenyayutsya ego neprirodnye sinteticheskie analogi. V otlichie ot nativnogo somatostatina, svyazyvayuschegosya so vsemi sstr (1–5) s vysokoy affinnost'yu i specifichnost'yu, analogi somatostatina vzaimodeystvuyut sstr2, sstr3 i sstr5. Diagnoz neyroendokrinnyh opuholey obychno stavitsya na osnovanii klinicheskoy simptomatiki, dannyh gistologicheskogo i immunogistohomicheskogo issledovaniy s ocenkoy gormonal'noy ekspressii. K sozhaleniyu, ispol'zovanie tradicionnyh diagnosticheskih metodov ne vsegda v polnoy mere pozvolyaet ocenit' rasprostranennost' opuholevogo processa, chto obuslovlivaet neobhodimost' sozdaniya novyh vizualiziruyuschih agentov. Primenenie metodov yadernoy mediciny, osobenno vypolnenie PET issledovaniy, v dannom sluchae demonstriruet vysokie pokazateli chuvstvitel'nosti i specifichnosti. Stremitel'noe razvitie personificirovannoy mediciny pozvolyaet ispol'zovat' effektivnye molekulyarnye misheni takzhe i dlya radionuklidnoy terapii onkologicheskih zabolevaniy. Otnositel'no nedavno etot princip byl primenen dlya neyroendokrinnyh opuholey s primeneniem pary 68Ga-DOTATATE/177Lu-DOTA-oktreotid, kotorye uspeshno ispol'zuyutsya vo mnogih yadernyh medicinskih centrah. Takim obrazom, v nastoyaschee vremya mechennye analogi somatostatina shiroko ispol'zuyutsya kak dlya radionuklidnoy diagnostiki neyroendokrinnyh opuholey, tak i dlya radionuklidnoy terapii ukazannyh novoobrazovaniy. Metody yadernoy mediciny obladayut vysokimi pokazatelyami chuvstvitel'nosti i specifichnosti, osobenno pri vypolnenii PET-issledovaniy. Mnogocentrovye issledovaniya v otnoshenii radionuklidnoy terapii neyroendokrinnyh opuholey prodemonstrirovali vysokie pokazateli ee effektivnosti i dokazali bezopasnost' ee primeneniya. V to zhe vremya v Rossiyskoy Federacii zaregistrirovan lish' odin preparat dlya vizualizacii neyroendokrinnyh opuholey – 111In-oktreotid, chto obuslavlivaet neobhodimost' vypolneniya issledovaniy po razrabotke novyh otechestvennyh diagnosticheskih i terapevticheskih radiofarmpreparatov.
neyroendokrinnye opuholi, somatostatinovye receptory, radiofarmpreparaty, teranostika
Нейроэндокринные опухоли (НЭО) представляют собой редкую и достаточно гетерогенную группу онкологических заболеваний с разнообразной клинико‑морфологической симптоматикой и биологическими особенностями. По эпидемиологическим данным, бόльшая часть НЭО представлена опухолями желудочно‑кишечного тракта и поджелудочной железы, что составляет 1–4 % всех злокачественных образований (ЗНО) пищеварительной системы и 60 % всех НЭО. Бронхопульмональные НЭО представлены 3 % всех ЗНО данной локализации и примерно 25 % всех НЭО. Несмотря на то, что НЭО считаются достаточно редкой онкологической патологией, в настоящее время отмечается непрерывный рост заболеваемости, в частности вследствие повышения качества диагностики на основе широкого внедрения в медицинские стандарты эндоскопических методов исследования.
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