Di Carlo V, Stella M, De Nardi P, Fazio F
Department of Surgery, University of Milano, S. Raffaele Hospital, Italy.
Tumori. 1995 May-Jun;81(3 Suppl):98-102.
The intraoperative detection of tumors by means of a gamma-ray detector that recognized radiolabelled monoclonal antibodies (MoAbs) on tumour cell surfaces has been shown to be feasible and clinically useful. The technology is called the Radioimmunoguided Surgery (RIGS) system. We have been working with this system for five years and in this paper we report our experience using different radiolabelled MoAbs and methods in terms of clinical utility in patients with primary or recurrent colorectal cancer. In the first part of the experience we injected with the MoAb B72.3 a group of 66 patients with primary (36) or recurrent (30) cancer introducing for 7 out of 66 a variation of the method to try to overcome some limits of the original procedure. With the new method, based on the avidin-biotin binding, it is possible to use anti-Cea MoAbs and to reduce the preoperative waiting time, injecting biotinylated MoAbs and avidin. In the second part of the experience, a second group of 15 patients with primary (12) and recurrent (3) cancer was injected with biotinylated MoAbs FO23C5 (anti-Cea) while in a third group of 16 patients, 6 with primary and 10 with recurrent cancer a cocktail of antibodies was used. During surgery a probe (NEOPROBE) was used to count obvious tumor, surrounding normal tissue and to scan the abdomen for areas of increased radioactivity. In the first group of patients tumour was localized by probe in 18/36 (50%) cases of primary cancer and in 24 out of 30 recurrences (80%). In the second group tumour was localized in 8/12 (67%) primary cancers and in 2 out of 3 (67%) recurrences. In the last group primary tumours were localized in 5/6 (83%) patients and recurrent cancer in 7/10 (70%). The method altered the surgical procedure in 2 out of 36 primary tumours (6%) and in 8 out of 30 recurrences (27%) injected with the B72.3. In the group of 15 patients injected with the anti-Cea the method changed the surgical strategy in 2/12 (16%) primaries and in 1 out of 3 recurrences. We had no real clinical utility in the primary cancers injected with cocktails but in 4 out of 10 (40%) patients with recurrent cancer it was possible to localize occult metastatic tissue. In conclusion, the sensitivity of the different MoAbs is similar in the groups even though it is noted that B72.3 seems to be more indicated in recurrent cancers and the FO23C5 in primary tumors.(ABSTRACT TRUNCATED AT 400 WORDS)
通过伽马射线探测器在术中检测肿瘤已被证明是可行的且具有临床实用性，该探测器可识别肿瘤细胞表面的放射性标记单克隆抗体（MoAbs）。这项技术被称为放射免疫导向手术（RIGS）系统。我们使用该系统已达五年，在本文中，我们报告了在原发性或复发性结直肠癌患者中使用不同放射性标记MoAbs及方法的临床应用经验。在经验的第一部分，我们给一组66例原发性（36例）或复发性（30例）癌症患者注射了MoAb B72.3，其中66例中有7例对方法进行了改进，试图克服原方法的一些局限性。新方法基于抗生物素蛋白-生物素结合，可使用抗癌胚抗原（Cea）MoAbs并减少术前等待时间，即注射生物素化MoAbs和抗生物素蛋白。在经验的第二部分，第二组15例原发性（12例）和复发性（3例）癌症患者注射了生物素化MoAbs FO23C5（抗Cea），而在第三组16例患者中，6例原发性和10例复发性癌症患者使用了抗体混合物。手术期间，使用一个探头（NEOPROBE）对明显肿瘤、周围正常组织进行计数，并扫描腹部寻找放射性增强区域。在第一组患者中，探头在18/36（50%）的原发性癌症病例和30例复发病例中的24例（80%）中定位到了肿瘤。在第二组中，肿瘤在8/12（67%）的原发性癌症和3例复发病例中的2例（67%）中被定位。在最后一组中，原发性肿瘤在5/6（83%）的患者中被定位，复发性癌症在7/10（70%）的患者中被定位。该方法改变了36例原发性肿瘤中的2例（6%）和注射B72.3的30例复发病例中的8例（27%）的手术方式。在注射抗Cea的15例患者组中，该方法改变了12例原发性肿瘤中的2例（16%）和3例复发病例中的1例的手术策略。我们在注射抗体混合物的原发性癌症中未发现真正的临床实用性，但在复发性癌症的10例患者中的4例（40%）中能够定位隐匿性转移组织。总之，尽管注意到B72.3似乎更适用于复发性癌症，而FO23C5更适用于原发性肿瘤，但不同MoAbs在各组中的敏感性相似。（摘要截选至400字）
