Wygoda Zbigniew, Kula Dorota, Bierzyńska-Macyszyn Grazyna, Larysz Dawid, Jarzab Michał, Właszczuk Paweł, Bazowski Piotr, Wojtacha Maciej, Rudnik Adam, Stepień Tomasz, Kaspera Wojciech, Etmańska Aleksandra, Składowski Krzysztof, Tarnawski Rafał, Kokocińska Danuta, Jarzab Barbara
Department of Nuclear Medicine and Endocrine Oncology, Maria Skłodowska-Curie Memorial Institute and Center of Oncology, Gliwice, Poland.
Hybridoma (Larchmt). 2006 Jun;25(3):125-32. doi: 10.1089/hyb.2006.25.125.
We investigated the putative benefits of simultaneous teleradiotherapy and anti-epidermal growth factor receptor (EGFR) 125I monoclonal antibody (MAb) 425 radioimmunotherapy, when applied after neurosurgery in high-grade gliomas, over teleradiotherapy alone. In comparison to previous studies which have reported good results with this type of radioimmunotherapy, we advanced the adjuvant radioimmunotherapy step, that is, gave it during, not after, teleradiotherapy. The randomized prospective study examined two groups: simultaneous postoperative teleradiotherapy and radioimmunotherapy (TRT + RIT; eight patients) versus teleradiotherapy alone (TRT; 10 patients). Patients who after primary operation of grade III (6 cases) or IV glioma (12 cases), showed no or less than 2 mL of remnant tumor on post-operative magnetic resonance (MR) study and were not treated postoperatively by chemotherapy were enrolled and randomized. Anti-EGFR 125IMAb 425 RIT was started during week 4 of radiotherapy, not later than 8 weeks after neurosurgery, and was repeated three times at 1-week intervals. Total activity given was 5026 + 739 MBq/patient. The tolerance of TRT was good. No immediate side effects of concomitant anti-EGRF 125I RIT were observed. Observation showed a median total survival (as evaluated from the primary neurosurgical treatment) of 14 months (range 3.5-28 months). There was no improvement in disease-free or total survival in the group of patients treated by TRT + RIT after neurosurgery. In addition, an immunohistochemical analysis of EGFR expression in gliomas was performed in a group of 100 cases and was distinctly positive in 50% grade IV gliomas and 68% grade III gliomas. We conclude that simultaneous radiotherapy and radioimmunotherapy with anti-EGFR 125I-MAb 425 is not beneficial over radiotherapy alone in adjuvant treatment of high-grade gliomas after neurosurgery. We also recommend individual confirmation of EGFR expression in further anti-EGFR radioimmunotherapy trials.
我们研究了同步远程放疗与抗表皮生长因子受体（EGFR）125I单克隆抗体（MAb）425放射免疫疗法在高级别胶质瘤神经外科手术后应用时相对于单纯远程放疗的假定益处。与之前报道这种放射免疫疗法取得良好效果的研究相比，我们将辅助放射免疫疗法的步骤提前了，即在远程放疗期间而非之后进行。这项随机前瞻性研究考察了两组：同步术后远程放疗和放射免疫疗法（TRT + RIT；8例患者）与单纯远程放疗（TRT；10例患者）。纳入并随机分组的患者为III级（6例）或IV级胶质瘤（12例）患者，他们在初次手术后，术后磁共振（MR）检查显示无残留肿瘤或残留肿瘤少于2 mL，且术后未接受化疗。抗EGFR 125I MAb 425放射免疫疗法在放疗第4周开始，不晚于神经外科手术后8周，并以1周的间隔重复3次。每位患者给予的总活度为5026 + 739 MBq。TRT的耐受性良好。未观察到同步抗EGRF 125I放射免疫疗法的即刻副作用。观察显示，（从初次神经外科治疗开始评估）中位总生存期为14个月（范围3.5 - 28个月）。神经外科手术后接受TRT + RIT治疗的患者组在无病生存期或总生存期方面没有改善。此外，对100例胶质瘤患者进行了EGFR表达的免疫组织化学分析，结果显示在50%的IV级胶质瘤和68%的III级胶质瘤中呈明显阳性。我们得出结论，在神经外科手术后高级别胶质瘤的辅助治疗中，同步放疗与抗EGFR 125I - MAb 425放射免疫疗法并不比单纯放疗更有益。我们还建议在进一步的抗EGFR放射免疫疗法试验中对EGFR表达进行个体确认。
