Riva P, Arista A, Franceschi G, Frattarelli M, Sturiale C, Riva N, Casi M, Rossitti R
Istituto Oncologico Romagnolo, Cesna, FO, Italy.
Cancer Res. 1995 Dec 1;55(23 Suppl):5952s-5956s.
Two murine monoclonal antibodies, BC-2 and BC-4, raised against tenascin and labeled with 131I were infused locally in the site of neoplastic disease by means of a removable (16 patients) or indwelling (34 patients) catheter. Fifty patients bearing a malignant glioma were treated. Twenty-six of these were suffering from recurrent disease; their tumors relapsed within 9 months (median) after treatment. The remaining 24 cases had a newly diagnosed tumor, and local radioimmunotherapy (RIT) was given immediately after surgery and radiochemotherapy. All efforts were made to reduce the tumor before the infusion of the radiopharmaceutical. Therefore, 22 cases with relapsing glioma underwent additional debulking surgery, which led to total or subtotal removal of tumor in 9 of the patients. Altogether, 28 patients had intralesional RIT when the disease was minimal or microscopic. Conversely, 22 cases underwent local RIT with a tumor the diameter of which was > 2 cm. In many cases, the infusions were repeated up to six times to achieve complete destruction of the neoplastic tissue. The local treatment did not give rise to systemic or to cerebral adverse effects. The labeled monoclonal antibodies, given directly in the site of the lesion, concentrated in very high amount in the neoplastic tissue and remained fixed in the target for a long period of time. For these reasons, the radiation dose to the tumor was remarkable (on average > 30,000 cGy/cycle) and consequently led to promising results. The median survival was, in total, 20 months (18 in recurrent tumors and 23 in newly diagnosed lesions). Moreover, median survival was 17 months in patients with bulky tumors (both recurrent and newly diagnosed tumors) and 26 months in patients with minimal or microscopic disease. The median time to progression was 3 months in recurrent and 7 months in newly diagnosed gliomas. Finally, RIT produced 3 CRs (all in recurrent tumors), 6 PRs (4 in recurrent and 2 in newly diagnosed), and 11 stabilizations of disease (4 in recurrent and 7 in newly diagnosed). In 19 cases (13 recurrent and 6 newly diagnosed) the progression of tumor was recorded. Eleven patients (2 recurrent and 9 newly diagnosed) who were treated by RIT when their disease was minimal and nondetectable by radiological methods remained disease-free and were classified as NED. The overall response rate (NED plus CR plus PR) was 40% (34.6% recurrent and 45.8% newly diagnosed).(ABSTRACT TRUNCATED AT 400 WORDS)
两种针对腱生蛋白产生的鼠单克隆抗体BC - 2和BC - 4，用131I标记后，通过可移除导管（16例患者）或留置导管（34例患者）局部注入肿瘤病灶部位。对50例患有恶性胶质瘤的患者进行了治疗。其中26例为复发性疾病，他们的肿瘤在治疗后9个月（中位数）内复发。其余24例为新诊断的肿瘤，在手术及放化疗后立即给予局部放射免疫治疗（RIT）。在注入放射性药物之前，尽一切努力缩小肿瘤。因此，22例复发性胶质瘤患者接受了额外的肿瘤减量手术，其中9例患者实现了肿瘤的全部或部分切除。总之，28例患者在疾病处于最小或显微镜下可见状态时接受了瘤内RIT治疗。相反，22例患者的肿瘤直径>2 cm时接受了局部RIT治疗。在许多情况下，重复注入多达6次以实现肿瘤组织的完全破坏。局部治疗未引起全身或脑部不良反应。直接注入病变部位的标记单克隆抗体在肿瘤组织中大量聚集，并在靶点长时间停留。由于这些原因，肿瘤接受的辐射剂量显著（平均>30,000 cGy/周期），因此取得了有前景的结果。总体中位生存期为20个月（复发性肿瘤为18个月,新诊断病变为23个月）。此外，大体积肿瘤患者（包括复发性和新诊断肿瘤）的中位生存期为17个月，疾病处于最小或显微镜下可见状态的患者中位生存期为26个月。复发性胶质瘤的中位进展时间为3个月，新诊断胶质瘤为7个月。最后，RIT产生了3例完全缓解（CR，均为复发性肿瘤），6例部分缓解（PR，4例为复发性肿瘤，2例为新诊断肿瘤），以及11例疾病稳定（4例为复发性肿瘤，7例为新诊断肿瘤）。19例（13例复发性肿瘤和6例新诊断肿瘤）记录到肿瘤进展。11例患者（2例复发性肿瘤和9例新诊断肿瘤）在疾病处于最小且影像学方法无法检测到时接受了RIT治疗，保持无病状态，被归类为无疾病证据（NED）。总缓解率（NED加CR加PR）为40%（复发性肿瘤为34.6%，新诊断肿瘤为45.8%）。
