Paganelli Giovanni, Ferrari Mahila, Ravasi Laura, Cremonesi Marta, De Cicco Concetta, Galimberti Viviana, Sivolapenko Gregory, Luini Alberto, De Santis Rita, Travaini Laura Lavinia, Fiorenza Maurizio, Chinol Marco, Papi Stefano, Zanna Claudio, Carminati Paolo, Veronesi Umberto
Division of Nuclear Medicine, European Institute of Oncology, Milan, Italy.
Clin Cancer Res. 2007 Sep 15;13(18 Pt 2):5646s-5651s. doi: 10.1158/1078-0432.CCR-07-1058.
In a continuous effort to seek for anticancer treatments with minimal side effects, we aim at proving the feasibility of the Intraoperative Avidination for Radionuclide Therapy, a new procedure for partial breast irradiation.
To assess doses of 90Y-DOTA-biotin to target (i.e., breast tumor bed) and nontarget organs, we did simulation studies with 111In-DOTA-biotin in 10 candidates for conservative breast surgery. Immediately after quadrantectomy, patients were injected with 100-mg avidin in the tumor bed. On the following day, patients were given 111In-DOTA-biotin (approximately 111 MBq) i.v. after appropriate chase of biotinylated albumin (20 mg) to remove circulating avidin. Biokinetic studies were done by measuring radioactivity in scheduled blood samples, 48-h urine collection, and through scintigraphic images. The medical internal radiation dose formalism (OLINDA code) enabled dosimetry assessment in target and nontarget organs.
Images showed early and long-lasting radioactive biotin uptake in the operated breast. Rapid blood clearance (<1% at 12 h) and urine excretion (>75% at 24 h) were observed. Absorbed doses, expressed as mean+/-SD in Gy/GBq, were as low as 0.15+/-0.05 in lungs, 0.10+/-0.02 in heart, 0.06+/-0.02 in red marrow, 1.30+/-0.50 in kidneys, 1.50+/-0.30 in urinary bladder, and 0.06+/-0.02 in total body, whereas in the targeted area, they increased to 5.5+/-1.1 Gy/GBq (50% ISOROI) and 4.8+/-1.0 Gy/GBq (30% ISOROI).
Our preliminary results suggest that Intraoperative Avidination for Radionuclide Therapy is a simple and feasible procedure that may improve breast cancer patients' postsurgical management by shortening radiotherapy duration.
为持续寻求副作用最小的抗癌治疗方法，我们旨在证明术中抗生物素蛋白化用于放射性核素治疗的可行性，这是一种局部乳腺照射的新方法。
为评估90Y-DOTA-生物素对靶器官（即乳腺肿瘤床）和非靶器官的剂量，我们对10名拟行保乳手术的患者用111In-DOTA-生物素进行了模拟研究。象限切除术后立即在肿瘤床注射100毫克抗生物素蛋白。次日，在适当注射生物素化白蛋白（20毫克）以清除循环中的抗生物素蛋白后，静脉注射111In-DOTA-生物素（约111MBq）。通过测量预定血样中的放射性、收集48小时尿液以及通过闪烁图像进行生物动力学研究。医学内照射剂量学形式（OLINDA代码）可对靶器官和非靶器官进行剂量学评估。
图像显示手术侧乳腺有早期且持久的放射性生物素摄取。观察到血液快速清除（12小时时<1%）和尿液排泄（24小时时>75%）。以Gy/GBq表示的吸收剂量，平均值±标准差在肺中低至0.15±0.05，心脏中为0.10±0.02，红骨髓中为0.06±0.02，肾脏中为1.30±0.50，膀胱中为1.50±0.30，全身为0.06±0.02，而在靶区，吸收剂量增加到5.5±1.1 Gy/GBq（50%等剂量率）和4.8±1.0 Gy/GBq（30%等剂量率）。
我们的初步结果表明，术中抗生物素蛋白化用于放射性核素治疗是一种简单可行的方法，可能通过缩短放疗时间改善乳腺癌患者的术后管理。
