Intraoperative avidination for radionuclide therapy: a prospective new development to accelerate radiotherapy in breast cancer.
OBJECTIVE
In a continuous effort to seek for anticancer treatments with minimal side effects, we aim at proving the feasibility of the Intraoperative Avidination for Radionuclide Therapy, a new procedure for partial breast irradiation.


METHODS
To assess doses of 90Y-DOTA-biotin to target (i.e., breast tumor bed) and nontarget organs, we did simulation studies with 111In-DOTA-biotin in 10 candidates for conservative breast surgery. Immediately after quadrantectomy, patients were injected with 100-mg avidin in the tumor bed. On the following day, patients were given 111In-DOTA-biotin (approximately 111 MBq) i.v. after appropriate chase of biotinylated albumin (20 mg) to remove circulating avidin. Biokinetic studies were done by measuring radioactivity in scheduled blood samples, 48-h urine collection, and through scintigraphic images. The medical internal radiation dose formalism (OLINDA code) enabled dosimetry assessment in target and nontarget organs.


RESULTS
Images showed early and long-lasting radioactive biotin uptake in the operated breast. Rapid blood clearance (<1% at 12 h) and urine excretion (>75% at 24 h) were observed. Absorbed doses, expressed as mean+/-SD in Gy/GBq, were as low as 0.15+/-0.05 in lungs, 0.10+/-0.02 in heart, 0.06+/-0.02 in red marrow, 1.30+/-0.50 in kidneys, 1.50+/-0.30 in urinary bladder, and 0.06+/-0.02 in total body, whereas in the targeted area, they increased to 5.5+/-1.1 Gy/GBq (50% ISOROI) and 4.8+/-1.0 Gy/GBq (30% ISOROI).


CONCLUSIONS
Our preliminary results suggest that Intraoperative Avidination for Radionuclide Therapy is a simple and feasible procedure that may improve breast cancer patients' postsurgical management by shortening radiotherapy duration.
Paganelli
Giovanni
G
Division of Nuclear Medicine, European Institute of Oncology, Milan, Italy. divisione.medicinanucleare@ieo.it
Ferrari
Mahila
M
Ravasi
Laura
L
Cremonesi
Marta
M
De Cicco
Concetta
C
Galimberti
Viviana
V
Sivolapenko
Gregory
G
Luini
Alberto
A
De Santis
Rita
R
Travaini
Laura Lavinia
LL
Fiorenza
Maurizio
M
Chinol
Marco
M
Papi
Stefano
S
Zanna
Claudio
C
Carminati
Paolo
P
Veronesi
Umberto
U
D000293:Adolescent; D000328:Adult; D000368:Aged; D001360:Avidin / Q000008:administration & dosage* / Q000493:pharmacokinetics; D001710:Biotin / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000493:pharmacokinetics; D001918:Brachytherapy / Q000379:methods*; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000532:radiotherapy* / Q000601:surgery; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007205:Indium Radioisotopes; D015552:Injections, Intralesional; D007275:Injections, Intravenous; D007432:Intraoperative Period; D015412:Mastectomy, Segmental; D008875:Middle Aged; D009942:Organometallic Compounds / Q000008:administration & dosage* / Q000493:pharmacokinetics; D010865:Pilot Projects; D011446:Prospective Studies; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D018714:Radiotherapy, Adjuvant; D021701:Sentinel Lymph Node Biopsy; D014018:Tissue Distribution; D015021:Yttrium Radioisotopes
C405616:DOTA-biotin; D007205:Indium Radioisotopes; D009942:Organometallic Compounds; D019275:Radiopharmaceuticals; D015021:Yttrium Radioisotopes; D001360:Avidin; D001710:Biotin