Radioimmunoguided surgery benefits for recurrent colorectal cancer.
BACKGROUND
Despite new adjuvant therapy, 50% of patients with colon cancer will have recurrent disease. This study investigated the use of a radiolabeled monoclonal antibody in locating occult tumor during surgery for recurrent colorectal cancer.


METHODS
Twenty-two patients with recurrent colorectal cancer underwent surgery using the radioimmunoguided surgery (RIGS) system. All patients were subjected to abdominal and chest computed tomography (CT). Before surgery, patients were injected with the CC49 monoclonal antibody (MoAb), anti-TAG antibody labeled with 125I. Ten patients with elevated carcinoembryonic antigen (CEA) levels and no CT findings had a scintigraphy scan with an anti-CEA MoAb labeled with 99Tc. Human antimouse antibody levels of these patients were within normal limits. Surgical exploration including liver ultrasound examination was followed by survey with a gamma-detecting probe (GDP).


RESULTS
There was MoAb tumor localization in 100% of the patients. CT found nine tumor sites, traditional surgical exploration 30, and the GDP 51, with 44 confirmed by pathology (hematoxylin and eosin). The RIGS system found occult tumor in 10 patients (45.4%) and resulted in major changes in surgical procedure in 11 patients. In the 10 patients who had scintigraphy scans, 10 tumor sites were identified, whereas RIGS found an additional eight sites.


CONCLUSIONS
RIGS technology offers a substantial benefit for patients undergoing surgery for recurrent colorectal cancer and a better chance of finding recurrent tumor intraoperatively in patients who have elevated CEA levels with no other CT findings.
Schneebaum
S
S
Department of Surgery A, Ichilov Hospital, Tel-Aviv Sourasky Medical Center, Israel.
Papo
J
J
Graif
M
M
Baratz
M
M
Baron
J
J
Skornik
Y
Y
D000008:Abdominal Neoplasms / Q000000981:diagnostic imaging* / Q000556:secondary / Q000601:surgery*; D000911:Antibodies, Monoclonal; D002272:Carcinoembryonic Antigen / Q000276:immunology; D015179:Colorectal Neoplasms / Q000473:pathology*; D006801:Humans; D007432:Intraoperative Period; D007457:Iodine Radioisotopes; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary / Q000601:surgery; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging; D010386:Pelvic Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary / Q000601:surgery; D016719:Radioimmunodetection; D012680:Sensitivity and Specificity
D000911:Antibodies, Monoclonal; D002272:Carcinoembryonic Antigen; D007457:Iodine Radioisotopes