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Intraoperative avidination for radionuclide treatment as a radiotherapy boost in breast cancer: results of a phase II study with 90Y-labeled biotin

  • Giovanni Paganelli
  • Concetta De Cicco
  • Mahila E. Ferrari
  • Giuseppe Carbone
  • Gianmatteo Pagani
  • Maria Cristina Leonardi
  • Marta Cremonesi
  • Annamaria Ferrari
  • Monica Pacifici
  • Amalia Di Dia
  • Rita De Santis
  • Viviana Galimberti
  • Alberto Luini
  • Roberto Orecchia
  • Stefano Zurrida
  • Umberto Veronesi
Original Article

Abstract

Purpose

External beam radiotherapy (EBRT) after conservative surgery for early breast cancer requires 5–7 weeks. For elderly patients and those distant from an RT center, attending for EBRT may be difficult or impossible. We investigated local toxicity, cosmetic outcomes, and quality of life in a new breast irradiation technique—intraoperative avidination for radionuclide therapy (IART)—in which avidin is administered to the tumor bed and 90Y-labelled biotin later administered intravenously to bind the avidin and provide irradiation. Reduced duration EBRT (40 Gy) is given subsequently.

Methods

After surgery, 50 (ten patients), 100 (15 patients) or 150 mg (ten patients) of avidin was injected into the tumor bed. After 12-24 h, 3.7 GBq 90Y-biotin (beta source for therapeutic effect) plus 185 MBq 111In-biotin (gamma source for imaging and dosimetry) was infused slowly. Whole-body scintigraphy and SPECT/CT images were taken for up to 30 h. Shortened EBRT started 4 weeks later. Local toxicity was assessed by RTOG scale; quality of life was assessed by EORTC QOL-30.

Results

Of 35 patients recruited (mean age 63 years; range 42–74) 32 received IART plus EBRT. 100 mg avidin provided 19.5 ± 4.0 Gy to the tumor bed and was considered the optimum dose. No side-effects of avidin or 90Y-biotin occurred, with no hematological or local toxicity. Local G3 toxicity occurred in 3/32 patients during EBRT. IART plus EBRT was well accepted, with good cosmetic outcomes and maintained quality of life.

Conclusions

IART plus reduced EBRT can accelerate irradiation after conservative breast surgery.

Keywords

Avidin Biotin Breast cancer Radiotherapy Molecular radionuclide therapy 

Notes

Acknowledgements

This study was supported by grants from the Italian Association for Cancer Research (AIRC). The authors thank Don Ward for help with the English and Deborah Console for editing the manuscript.

Conflicts of interest

G. Paganelli is a consultant to Sigma-Tau SpA. R. De Santis receives salaries from Sigma-Tau SpA. All other authors declared that they have no conflicts of interest.

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Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Giovanni Paganelli
    • 1
  • Concetta De Cicco
    • 1
  • Mahila E. Ferrari
    • 2
  • Giuseppe Carbone
    • 1
  • Gianmatteo Pagani
    • 3
  • Maria Cristina Leonardi
    • 4
  • Marta Cremonesi
    • 2
  • Annamaria Ferrari
    • 4
  • Monica Pacifici
    • 1
  • Amalia Di Dia
    • 2
  • Rita De Santis
    • 5
  • Viviana Galimberti
    • 3
  • Alberto Luini
    • 3
  • Roberto Orecchia
    • 4
  • Stefano Zurrida
    • 3
    • 6
  • Umberto Veronesi
    • 7
  1. 1.Division of Nuclear MedicineEuropean Institute of OncologyMilanItaly
  2. 2.Division of Medical PhysicsEuropean Institute of OncologyMilanItaly
  3. 3.Division of SenologyEuropean Institute of OncologyMilanItaly
  4. 4.Division of RadiotherapyEuropean Institute of OncologyMilanItaly
  5. 5.Sigma-Tau SpA R&DRomeItaly
  6. 6.University of Milan School of MedicineMilanItaly
  7. 7.Scientific DirectorEuropean Institute of OncologyMilanItaly

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