中国癌症杂志 ›› 2024, Vol. 34 ›› Issue (7): 702-714.doi: 10.19401/j.cnki.1007-3639.2024.07.010
• 指南与共识 • 上一篇
中国抗癌协会肿瘤核医学专业委员会, 中国医师协会核医学医师分会
收稿日期:
2024-04-19
修回日期:
2024-06-07
出版日期:
2024-07-30
发布日期:
2024-08-08
通信作者:
宋少莉(ORCID: 0000-0003-2544-7522),博士,主任医师、教授,复旦大学附属肿瘤医院核医学科主任;樊卫(ORCID: 0000-0001-5418-1714),博士,主任医师、教授,中山大学肿瘤防治中心核医学科主任。
Cancer Nuclear Medicine Committee of China Anti-Cancer Association, Chinese Association of Nuclear Medicine Physicians
Received:
2024-04-19
Revised:
2024-06-07
Published:
2024-07-30
Online:
2024-08-08
Contact:
SONG Shaoli; FAN Wei
文章分享
摘要:
镥-177标记前列腺特异性膜抗原放射性配体疗法(177Lu-labeled prostate-specific membrane antigen radioligand therapy,177Lu-PSMA-RLT)是一种通过精准地向前列腺癌细胞递送177Lu释放的β射线,引发肿瘤细胞DNA的辐射损伤从而杀灭肿瘤的创新治疗方法。现阶段国内外多个前列腺癌领域权威指南与共识推荐其用于治疗转移性去势抵抗性前列腺癌(metastatic castrate-resistant prostate cancer,mCRPC),国内尚未见关于177Lu-PSMA-RLT治疗前列腺癌的临床实践路径和用药规范的报道。本共识由中国抗癌协会肿瘤核医学专业委员会和中国医师协会核医学医师分会共同发起,结合现有的 177Lu-PSMA-RLT注册研究结果、真实世界数据及国内外放射性核素临床治疗经验,根据牛津循证医学中心临床证据推荐等级和证据级别来评价不同级别的证据,在适应证、患者筛选、用药不良反应、随访和辐射安全等方面给出推荐意见。本共识旨在为临床医师提供177Lu-PSMA-RLT治疗前列腺癌的临床参考,为进一步制订行业相关指南奠定基础。
中图分类号:
中国抗癌协会肿瘤核医学专业委员会, 中国医师协会核医学医师分会. 177Lu-PSMA放射性配体疗法治疗前列腺癌的临床实践专家共识(2024年版)[J]. 中国癌症杂志, 2024, 34(7): 702-714.
Cancer Nuclear Medicine Committee of China Anti-Cancer Association, Chinese Association of Nuclear Medicine Physicians. Expert consensus of 177Lu-labeled PSMA radioligand therapy for clinical practice of prostate cancer (2024 edition)[J]. China Oncology, 2024, 34(7): 702-714.
表3
《177Lu-PSMA放射性配体疗法治疗前列腺癌的临床实践专家共识(2024年版)》推荐意见汇总"
类别 | 推荐内容 | 推荐等级 |
---|---|---|
临床应用推荐 | ⑴ 对于已经获批的适应证,如果患者满足治疗条件,建议推荐患者使用177Lu-PSMA-RLT治疗 | A |
⑵ 若有充足证据表明患者可从治疗中显著获益,且风险可控,也应考虑使用177Lu-PSMA-RLT治疗 | A | |
⑶ 对于正在进行的临床研究和无其他治疗方式可选择的情况,需结合临床判断是否可以进行相关治疗 | C | |
临床应用注意事项 | ⑴ 应充分评估患者情况,尤其需要关注可能导致患者预后不良的因素 | A |
⑵ 肿瘤特征显著及实验室检查异常的患者或有疗效不显著的表现,若有明确指征,应及时对相关因素进行处理 | B | |
⑶ 影像学表现不佳及病灶摄取少带来的患者获益与风险之间的平衡应妥善评估,选择合适的治疗方案 | C | |
治疗前准备 | ⑴ 治疗应符合国家政策及相关规定,并在专用的核素治疗病房或核医学科专用的治疗室进行 | A |
⑵ 开始治疗前需与患者及家属进行充分的沟通,并完成实验室和影像学的相关检查 | A | |
⑶ 对于PSMA阳性的判断标准及患者是否有可能从177Lu-PSMA-RLT中获益,建议联合核医学科、泌尿外科、影像科及肿瘤内科等多学科团队专家进行讨论,综合判断患者是否适合进行治疗,并制订治疗方案 | B | |
治疗流程及给药后护理 | ⑴ 按照治疗性放射性药物给药方式注意事项 | C |
⑵ 可根据患者情况进行预防性用药 | C | |
⑶ 给药后4~72 h行SPECT/CT检查有助于评估药物分布情况 | B | |
临床观察及治疗后随访 | ⑴ 需关注患者治疗后出现的症状和体征,并告知患者及家属护理细节 | A |
⑵ 同时采用实验室检查及影像学检查进行随访,评估患者不良反应情况及疗效,根据检查结果及时调整用药方案或治疗方式 | A | |
常见的治疗后不良反应及处理 | ⑴ 当患者出现骨髓抑制、口干或涎腺损伤、骨痛等不良反应时,应积极联合多学科团队进行患者管理,避免因不良反应处理不及时而导致患者用药方案及剂量调整,影响疗效 | B |
辐射安全防护 | ⑴ 患者、家属、公众及医护人员均应注意辐射安全防护问题 | A |
⑵ 结合国内标准及国外经验,从辐射安全的角度考量,患者在专用的核素治疗病房或核医学科专用的治疗室治疗6 h后基本可满足1 m处的辐射剂量当量率符合离院标准,但是否让患者进行住院治疗需要医师结合患者实际情况及当地法律法规来进行综合判断 | B |
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