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3D dosimetry in patients with early breast cancer undergoing Intraoperative Avidination for Radionuclide Therapy (IART®) combined with external beam radiation therapy

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

Intraoperative Avidination for Radionuclide Therapy (IART®) is a novel targeted radionuclide therapy recently used in patients with early breast cancer. It is a radionuclide approach with 90Y-biotin combined with external beam radiotherapy (EBRT) to release a boost of radiation in the tumour bed. Two previous clinical trials using dosimetry based on the calculation of mean absorbed dose values with the hypothesis of uniform activity distribution (MIRD 16 method) assessed the feasibility and safety of IART®. In the present retrospective study, a voxel dosimetry analysis was performed to investigate heterogeneity in distribution of the absorbed dose. The aim of this work was to compare dosimetric and radiobiological evaluations derived from average absorbed dose vs. voxel absorbed dose approaches.

Methods

We evaluated 14 patients who were injected with avidin into the tumour bed after conservative surgery and 1 day later received an intravenous injection of 3.7 GBq of 90Y-biotin (together with 185 MBq 111In-biotin for imaging). Sequential images were used to estimate the absorbed dose in the target region according to the standard dosimetry method (SDM) and the voxel dosimetry method (VDM). The biologically effective dose (BED) distribution was also evaluated. Dose/volume and BED volume histograms were generated to derive equivalent uniform BED (EUBED) and equivalent uniform dose (EUD) values.

Results

No “cold spots” were highlighted by voxel dosimetry. The median absorbed-dose in the target region was 20 Gy (range 15–27 Gy) by SDM, and the median EUD was 20.4 Gy (range 16.5–29.4 Gy) by the VDM; SDM and VDM estimates differed by about 6 %. The EUD/mean voxel absorbed dose ratio was >0.9 in all patients, indicative of acceptable uniformity in the target. The median BED and EUBED values were 21.8 Gy (range 15.9–29.3 Gy) and 22.8 Gy (range 17.3–31.8 Gy), respectively.

Conclusion

VDM highlighted the absence of significant heterogeneity in absorbed dose in the target. The EUD/mean absorbed dose ratio indicated a biological efficacy comparable to that of uniform distribution of absorbed dose. The VDM is recommended for improving accuracy, taking into account actual activity distribution in the target region. The radiobiological model applied allowed us to compare the effects of IART® with those of EBRT and to match the two irradiation modalities.

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Acknowledgments

This study was supported by grants from the Italian Association for Cancer Research (AIRC).

The authors thank Mrs. Grainne Tierney for her kind assistance in revising the English of this manuscript and Mrs. Deborah Console for the editing.

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Authors and Affiliations

  1. Division of Medical Physics, European Institute of Oncology, Milan, Italy

    Mahila E. Ferrari, Marta Cremonesi, Amalia Di Dia, Francesca Botta & Guido Pedroli

  2. Division of Nuclear Medicine, European Institute of Oncology, via Ripamonti 435, 20141, Milan, Italy

    Concetta De Cicco, Michele Calabrese & Giovanni Paganelli

  3. Medical Physics Unit, IRCCS Istituto Romagnolo per lo Studio e la Cura dei Tumori, Meldola, FC, Italy

    Anna Sarnelli

  4. Department of Radiation Oncology, Centro Regionale Oncologico Basilicata (IRCCS-CROB), Rionero in Vulture, PZ, Italy

    Piernicola Pedicini

  5. Division of Radiotherapy, European Institute of Oncology, Milan, Italy

    Roberto Orecchia

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  1. Mahila E. Ferrari
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  11. Giovanni Paganelli
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Correspondence to Giovanni Paganelli.

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Ferrari, M.E., Cremonesi, M., Di Dia, A. et al. 3D dosimetry in patients with early breast cancer undergoing Intraoperative Avidination for Radionuclide Therapy (IART®) combined with external beam radiation therapy. Eur J Nucl Med Mol Imaging 39, 1702–1711 (2012). https://doi.org/10.1007/s00259-012-2197-6

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  • DOI: https://doi.org/10.1007/s00259-012-2197-6

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