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Eur J Nucl Med Mol Imaging. 2010 Feb;37(2):203-11. doi: 10.1007/s00259-009-1260-4. Epub 2009 Sep 4.

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

Author information

1
European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy. divisione.medicinanucleare@ieo.it

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 (90)Y-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 (90)Y-biotin (beta source for therapeutic effect) plus 185 MBq (111)In-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 (90)Y-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.

Comment in

PMID:
19760414
DOI:
10.1007/s00259-009-1260-4
[Indexed for MEDLINE]

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