Abstract
Breast cancer remains the most common cancer in women in the developed world and the most frequent cause of cancer-related death among women worldwide [1]. In 2010 in the United States, the estimated number of new cases of breast cancer was 207,090 (28 % of all cancer in women), with 39,840 expected deaths (second cause of death after lung and bronchus carcinoma) [2]. Fortunately, thanks to the screening campaigns carried out in the Western countries, breast cancer can be treated in its early phase. The conventional surgical treatment for early breast cancer consists of either a mastectomy or breast conserving surgery (BCS), often accompanied by axillary dissection or sentinel node biopsy. If BCS is performed, whole breast external beam radiotherapy (EBRT) with doses around 50–60 Gy remains the gold standard for local control. The benefit of postoperative radiotherapy is well known since the completion of few prospective randomized trials conducted in the years 1976–1990, which compared conservative surgery and radiation with conservative surgery alone. Several clinical trials compared also breast conservative surgery (BCS) alone vs. BCS followed by whole breast (WB) EBRT: 10–35 % of women receiving BCS alone showed locoregional recurrence, whilst it occurred only in 0.3–8 % of women after BCS plus WB-EBRT (follow-up range: 39–102 months), although both treatments produced the same 10-year overall survival rates [3]. However, there is some recent evidence that lack of radiotherapy is associated with an increased hazard ratio for death [4]. Current accepted treatment protocol takes advantage of the above experiences and consists of BCS, usually accompanied by axillary node dissection or sentinel node biopsy. If BCS is performed, it is almost always accompanied by postoperative regional radiotherapy; 2 Gy per day delivered five times a week for 6–8 weeks, for a total dose of 50–60 Gy to eliminate microscopic cancer foci remaining after surgery [5]. A substantial benefit of an additional boost with 16 Gy to the tumor bed was recently confirmed by the EORTC [6] particularly in premenopausal women.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Similar content being viewed by others
References
Anderson BO, Shyyan R, Eniu A, Smith RA, Yip CH, Bese NS, et al. Breast cancer in limited-resource countries: an overview of the Breast Health Global Initiative 2005 guidelines. Breast J. 2006;12 Suppl 1:S3–15.
Jemal A, Siegel R, Xu J, Ward E. Cancer statistics, 2010. CA Cancer J Clin. 2010;60(5):277–300.
Veronesi U, Luini A, Galimberti V, Zurridda S. Conservation approaches for the management of stage I/II carcinoma of the breast: Milan Cancer Institute trials. World J Surg. 1994;18:70–5.
Dragun AE, Huang B, Tucker TC, Spanos WJ. Disparities in the application of adjuvant radiotherapy after breast-conserving surgery for early stage breast cancer: impact on overall survival. Cancer. 2011;117(12):2590–8.
NHI Consensus Conference. Treatment of early breast cancer. JAMA. 1991;265:391–5.
Bartelink H, Horiot JC, Poortmans P, et al. European Organization for Research and Treatment of Cancer Radiotherapy and Breast Cancer Groups. Recurrence rates after treatment of breast cancer with standard radiotherapy with or without additional radiation. N Engl J Med. 2001;345:1378–87.
Jones HA, Antonini N, Hart AAM, et al. Impact of pathological characteristics on local relapse after breast-conserving therapy: a subgroup analysis of the EORTC boost versus no boost trial. J Clin Oncol. 2009;27:4939–47.
Ivaldi GB, et al. Preliminary results of electron intraoperative therapy boost and hypofractionated external beam radiotherapy after breast conserving surgery in premenopausal women. Int J Radiat Oncol Biol Phys. 2008;72(2):485–93.
Reitsamer R, Peintinger F, Sedlmayer F, Kopp M, Menzel C, Cimpoca W, et al. Intraoperative radiotherapy given as a boost after breast-conserving surgery in breast cancer patients. Eur J Cancer. 2002;38(12):1607–10.
Lemanski C, Azria D, Thezenas S, Gutowski M, Saint-Aubert B, Rouanet P, et al. Intraoperative radiotherapy given as a boost for early breast cancer: long-term clinical and cosmetic results. Int J Radiat Oncol Biol Phys. 2006;64(5):1410–5.
De Cicco C, Pizzamiglio M, Trifirò G, Luini A, Ferrari M, Prisco G, et al. Radioguided occult lesion localisation (ROLL) and surgical biopsy in breast cancer: technical aspects. Q J Nucl Med. 2002;46:145–51.
Goldenberg DM, Sharkey RM, Paganelli G, Barbet J, Chatal JF. Antibody pretargeting advances cancer radioimmunodetection and radioimmunotherapy. J Clin Oncol. 2006;24:823–34.
Grana C, Chinol M, Robertson C, Mazzetta C, Bartolomei M, De Cicco C, et al. Pretargeted adjuvant radioimmunotherapy with Yttrium-90-biotin in malignant glioma patients: a pilot study. B J Cancer. 2002;86:207–12.
Paganelli G, Grana C, Chinol M, Cremonesi M, De Cicco C, De Braud F, et al. Antibody-guided three-step therapy for high grade glioma with yttrium-90 biotin. Eur J Nucl Med. 1999;26(4):348–57.
Paganelli G, Ferrari M, Cremonesi M, De Cicco C, Galimberti V, Luini A, et al. IART®: intraoperative avidination for radionuclide treatment. A new way of partial breast irradiation. Breast. 2007;16:17–26.
Paganelli G, De Cicco C, Ferrari M, Carbone G, Pagani G, Leonardi MC, et al. Intraoperative avidination for radionuclide treatment as a radiotherapy boost in breast cancer: results of a phase II study with 90Y-labeled biotin. Eur J Nucl Med Mol Imaging. 2010;37:203–11.
Paganelli G, Ferrari M, Ravasi L, Cremonesi M, De Cicco C, Galimberti V, et al. Intraoperative avidination for radionuclide therapy: a prospective new development to accelerate radiotherapy in breast cancer. Clin Cancer Res. 2007;13 Suppl 18:5646s–51.
Wilchek M, Bayer EA. The avidin-biotin complex in immunology. Immunol Today. 1984;5:39–43.
Schubiger PA, Alberto R, Smith A. Vehicles, chelators, and radionuclides: choosing the “Building Block” of an effective therapeutic radioimmunoconjugate. Bioconjug Chem. 1996;7:165–79.
Wyatt RM, Beddoe AH, Dale RG. The effects of delays in radiotherapy treatment on tumour control. Phys Med Biol. 2003;48:139–55.
Mackillop WJ, et al. The effect of delay in treatment on local control by radiotherapy. Int J Radiat Oncol Biol Phys. 1996;34(1):243–50.
Mackillop WJ, et al. Does delay in starting treatment affect the outcomes of radiotherapy? A systematic review. J Clin Oncol. 2003;21(3):555–63.
Cassady JR. Clinical radiation nephropathy. Int J Radiat Oncol Biol Phys. 1995;31:1249–56.
Emami B, Lyman J, Brown A, et al. Tolerance of normal tissue to therapeutic irradiation. Int J Radiat Oncol Biol Phys. 1991;21:109–22.
Wessels BW, Konijnenberg MB, Dale RG, Breitz HB, Cremonesi M, Meredith RF, et al. MIRD Pamphlet No. 20: the effect of model assumptions on kidney dosimetry and response: implications for radionuclide therapy. J Nucl Med. 2008;49:1884–99.
Poortmans PM, et al. The addition of a boost dose on the primary tumour bed after lumpectomy in breast conserving treatment for breast cancer. A summary of the results of EORTC 22881-10882 “boost versus no boost” trial. Cancer Radiother. 2008;2(6–7):565–70.
Reitsamer R, et al. The Salzburg concept of intraoperative radiotherapy for cancer: results and considerations for breast. Int J Cancer. 2006;118:2882–7.
Veronesi U, Salvadori B, Luini A, et al. Breast conservation is a safe method in patients with small cancer of the breast. Long term results of three randomized trials on 1973 patients. Eur J Cancer. 1995;31:1574–9.
Fisher B, Anderson S, Bryant J, et al. Twenty-year follow-up of a randomized trail comparing total mastectomy, lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med. 2002;347:1233–41.
The START Trialists’ Group. The UK Standardisation of Breast Radiotherapy (START) Trial A of radiotherapy hypofractionation for treatment of early breast cancer: a randomised trial. Lancet Oncol. 2008;9:331–41.
The START Trialists’ Group. The UK Standardisation of Breast Radiotherapy (START) Trial B of radiotherapy hypofractionation for treatment of early breast cancer: a randomised trial. Lancet. 2008;371:1098–107.
Paganelli G, Ferrari M, De Cicco C, et al. Intraoperative avidination for radionuclide treatment (IART®) post quadrantectomy in breast cancer: predicted dosimetry with 90Y-biotin. JNM. 2006;47:488P.
Dale R, Carabe-Fernandez A. The radiobiology of conventional radiotherapy and its application to radionuclide therapy. Cancer Biother Radiopharm. 2005;20(1):47.
Rosenstein BS, Lymberis SC, Formenti SC. Biologic comparison of partial breast irradiation protocols. Int J Radiat Oncol Biol Phys. 2004;60:1393–404.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2013 Springer Science+Business Media New York
About this chapter
Cite this chapter
De Cicco, C., Paganelli, G. (2013). Local Accelerated Radionuclide Breast Irradiation: Avidin-Biotin Targeting System. In: Aktolun, C., Goldsmith, S. (eds) Nuclear Medicine Therapy. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-4021-5_10
Download citation
DOI: https://doi.org/10.1007/978-1-4614-4021-5_10
Published:
Publisher Name: Springer, New York, NY
Print ISBN: 978-1-4614-4020-8
Online ISBN: 978-1-4614-4021-5
eBook Packages: MedicineMedicine (R0)