在Lu-177-DOTATATE治疗期间和之后,在高风险花红细胞瘤患者中管理catecholamine释放综合征
Tim E Phelps1, Jaydira Del Rivero2, Daniel S Chertow3
1Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA.
卢-177多酸 (Lu-177-TRT) 治疗罕见的体红细胞瘤和骨瘤 (PPGLs). 这项案例研究表明,高风险患者可以安全地使用Lu-177-TRT治疗,使用密集监测和尼卡迪平.
科学领域:
- 核医学是一种核医学.
- 在瘤学瘤学.
- 内分泌学 在内分泌学.
背景情况:
- 乳色细胞瘤和偏角细胞瘤 (PPGLs) 是一种罕见的神经内分泌瘤.
- 这些瘤表达体静止素受体 (SSTR),使它们成为像Lu-177-TRT.一样的受体放射性核酸治疗 (PRRT) 的候选人.
- 与Lu-177-TRT的PRRT提供了转移PPGL的治疗选择,但存在严重心血管事件的风险.
研究的目的:
- 描述高风险转移性PPGL患者接受Lu-177-TRT.治疗的管理策略.
- 突出预防性重症监护病房 (ICU) 入院和特定抗高血压干预措施的安全性和有效性.
主要方法:
- 一个78岁的患有转移性横瘤的病例研究,该病例接受NCT03206060.0.治疗.
- 预防性ICU入院与中央线放置和减少Lu-177-TRT剂量 (100mCi×4周期) 由于并发症.
- 持续监测生命体征,血液检查和血清类甲醇胺,并立即使用静脉注射尼卡迪平治疗高血压事件.
主要成果:
- 患者在第一个Lu-177-TRT输液后不久经历了严重的高血压反应 (240 mmHg缩),尽管剂量减少了.
- 通过静脉注射尼卡迪平,高血压反应得到了有效控制.
- 随后的注射剂量减少和选择性ICU入院的输注被很好地容忍.
结论:
- 接受Lu-177-TRT的转移性PPGL患者可以安全地使用适当的制剂进行治疗.
- 关键的管理策略包括员工培训,警监测,以及准备迅速干预静脉注射药物,如尼卡迪平.
- 积极的ICU入院和剂量修改可以帮助减轻高风险个体的风险.
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