title: Intraoperative avidination for radionuclide therapy: a prospective new development to accelerate radiotherapy in breast cancer.
abstract: 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.
authors: Division of Nuclear Medicine, European Institute of Oncology, Milan, Italy. divisione.medicinanucleare@ieo.it
authors: Giovanni
authors: G
authors: Paganelli
authors: Mahila
authors: M
authors: Ferrari
authors: Laura
authors: L
authors: Ravasi
authors: Marta
authors: M
authors: Cremonesi
authors: Concetta
authors: C
authors: De Cicco
authors: Viviana
authors: V
authors: Galimberti
authors: Gregory
authors: G
authors: Sivolapenko
authors: Alberto
authors: A
authors: Luini
authors: Rita
authors: R
authors: De Santis
authors: Laura Lavinia
authors: LL
authors: Travaini
authors: Maurizio
authors: M
authors: Fiorenza
authors: Marco
authors: M
authors: Chinol
authors: Stefano
authors: S
authors: Papi
authors: Claudio
authors: C
authors: Zanna
authors: Paolo
authors: P
authors: Carminati
authors: Umberto
authors: U
authors: Veronesi
mesh_terms: 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
chemical_list: C405616:DOTA-biotin; D007205:Indium Radioisotopes; D009942:Organometallic Compounds; D019275:Radiopharmaceuticals; D015021:Yttrium Radioisotopes; D001360:Avidin; D001710:Biotin