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The Quarterly Journal of Nuclear Medicine and Molecular Imaging 2004 September;48(3):220-8

Copyright © 2009 EDIZIONI MINERVA MEDICA

lingua: Inglese

Combined treatment of glioblastoma patients with locoregional pre-targeted 90Y-biotin radioimmunotherapy and temozolomide

Bartolomei M. 1, Mazzetta C. 2, Handkiewicz-Junak D. 1, Bodei L. 1, Rocca P. 1, Grana C. 1, Maira G. 3, Sturiale C. 4, Villa G. 5, Paganelli G. 1

1 Division of Nuclear Medicine IEO, Milan, Italy 2 Division of Epidemiology and Biostatistics IEO, Milan, Italy 3 Department of Neurosurgery Policlinico “A. Gemelli”, Rome, Italy 4 Department of Neurosurgery Ospedale “Bellaria”, Bologna, Italy 5 Division of Radiology IEO, Milan, Italy


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Aim. In a pre­vi­ous ­phase I-II ­study, the safe­ty pro­file and ­anti-­tumor effi­ca­cy of pre-tar­get­ing loco­re­gion­al radio­im­mu­no­ther­a­py (LR-RIT), ­based on the “3 ­step” meth­od, was ­assessed in 24 ­high-­grade gli­o­ma ­patients. The encour­ag­ing ­results in ­terms of low tox­ic­ity and objec­tive ­response ­rate (25%) prompt­ed us to con­tin­ue our ­study.
Methods. An anal­y­sis of 73 ­patients ­with hys­to­log­i­cal­ly con­firmed gli­o­blas­to­ma mul­ti­forme (GBM), treat­ed ­with the “3 ­step” 90Y-bio­tin ­based LR-RIT, is here­in report­ed. All ­patients had a cath­e­ter implant­ed at 2nd sur­gery and under­went at ­least 2 ­cycles of LR-RIT (­range 2-7) ­with 2 ­months inter­val. Thirty-­five out of 73 ­patients ­were ­also treat­ed ­with Temozolomide (TMZ). Two ­cycles of TMZ (200 mg/m2/day, for 5/28 ­days) ­were admin­is­tered in ­between ­each ­course of LR-RIT. Overall sur­vi­val (OS) and pro­gres­sion ­free sur­vi­val (PFS) ­were ret­ro­spec­tive­ly cal­cu­lat­ed.
Results. Stabilization of dis­ease was ­achieved in 75% of ­patients, ­while 25% pro­gressed.
In the 38 ­patients treat­ed ­with LR-RIT ­alone, ­median OS and PFS ­were respec­tive­ly 17.5 ­months (95%CI=[17-20]) and 5 ­months (95%CI=[4-8]), ­while in the 35 treat­ed ­with the com­bined treat­ment (LR-RIT+TMZ) respec­tive val­ues ­were 25 ­months (95%CI=[23-30]) and 10 ­months (95%CI=[9-18] (p<0.01). The addi­tion of TMZ to LR-RIT did not ­increase neu­ro­log­i­cal tox­ic­ity, and no ­major hemato­log­i­cal tox­ic­ity was ­observed.
Conclusion. These ­results con­firm the safe­ty and the effi­ca­cy of 90Y LR-RIT in recur­rent GBM ­patients; the addi­tion of TMZ sig­nif­i­cant­ly ­improved the over­all out­comes; a fur­ther con­trolled pros­pec­tive, ran­dom­ized ­study is ful­ly jus­ti­fied.

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