Personalized irradiation therapy for NMSC by rhenium-188 skin cancer therapy: a long-term retrospective study.

OBJECTIVES: This study aimed to provide long-term clinical data about an innovative epidermal radioisotope therapy called Rhenium-SCT® (Skin Cancer Therapy) for non-melanoma skin cancer (NMSC), based on the use of the non-sealed beta emitter rhenium-188. MATERIAL AND METHODS: 52 NMSC patients with a mean age of 71.7 years were treated with rhenium-188 skin cancer therapy between the years 2005 and 2014. An acryl matrix containing rhenium-188 was applied on a plastic foil covering the tumor. The treatment time for reaching a radiation dose of 50 Gy was calculated by a software program. Patients' characteristics and clinical follow-up data were collected and retrospectively analyzed. RESULTS: Overall 55 lesions (32 BCC, 19 SCC, 2 M. Bowen and 2 extramammary Paget's disease (EMPD)) mainly in the head and neck region (72.3%) were treated. The average size of the irradiation area was 9.79 cm2 and the mean treatment time 46.35 min. All lesions showed a complete remission after a follow-up period between 3 and more than 12 months. No complications or other post-interventional problems were reported. CONCLUSIONS: Rhenium-SCT® is considered as an effective, rapid, safe, painless treatment mostly performed in a single therapeutic session, regardless of the shape complexity, anatomical site and number of lesions.

Dermo beta brachytherapy with 188-Re in squamous cell carcinoma of the penis: a new therapy.

BACKGROUND: Squamous cell carcinoma of the penis (SCCP) is the most common penis neoplasia, favoured by phimosis, HPV infection and scleroatrophic lichen. The classic therapy is surgical with anatomic demolition, which often causes important psychological problems. Other non-demolitive therapies can be utilized, such as radiotherapy, brachytherapy and topical medical treatment. OBJECTIVES: We propose a new non-invasive therapy called "Dermo beta brachytherapy (DBBT) with 188-Re" in which a synthetic inert resin-matrix containing a radioactive beta-emitting isotope is applied on the surface of the tumor lesion. MATERIALS AND METHODS: A total of 15 patients with a histologically confirmed diagnosis of SCCP were enrolled for treatment (DBBT). RESULTS: Of the 15 patients, 12 healed, 1 was lost at follow-up and 2 did not respond to therapy. CONCLUSION: The results indicate that DBBT is an effective treatment for SCC of the penis, sparing the anatomical integrity of the organ, and allowing normal sexual activity.

Management of 131I therapy for thyroid cancer: cumulative dose from in-patients, discharge planning and personnel requirements.

AIM: To provide a comprehensive overview with regard to the hospitalization/discharge planning and nursing staff requirements for the management of patients treated with radioiodine for differentiated thyroid carcinoma. METHODS: A statistical analysis of the fast clearance phase of 131I was performed in 265 hospitalized patients treated after total thyroidectomy with fixed doses ranging from 2590 to 9250 MBq. RESULTS: Two hundred and twenty-five cases were post-surgical ablation treatments and 40 cases were follow-up treatments. The 131I clearance was studied during hospitalization of 2-4 days. No clearance differences were found between the two groups. The median value of the biological half-time (T1/2bio) was 0.65 days, with a variability range of 0.30-2.03 days. A statistical model for the distribution of T(1/2bio) was reported. Some patients on maintenance haemodialysis were also studied, with T(1/2bio) values ranging from 1.6 to 2.6 days. The weekly cumulative dose to personnel from external exposure, corresponding to the 95th percentile, ranged from 0.1 mSv per GBq of administered activity (mSv x GBq(-1)) with a totally ambulant patient to 5.4 mSv . GBq with a totally helpless patient. With patients on maintenance haemodialysis, these values could increase from 1.2 to 1.7 times. The cumulative dose to close relatives was also estimated. The hospitalization times associated with 75% and 95% probabilities of patient discharge were calculated by varying the residual activity limit from 100 to 800 MBq. Finally, using the median T(1/2bio), personnel requirements were evaluated. With totally ambulant and semi-ambulant patients, about 0.5 and 1.0 personnel units per GBq of weekly administered activity were needed so as not to exceed an annual planning dose of 6 mSv per year. The treatment of patients with higher degrees of dependency was impractical. CONCLUSIONS: On the basis of statistical analysis, a better organization of in-patient treatment may be obtained, as well as more accurate preliminary evaluations of the cumulative doses to nursing staff and attending personnel, for the management of patients treated with radioiodine for differentiated thyroid carcinoma.

Role of sentinel lymph node biopsy procedure in cervical cancer: a critical point of view.

OBJECTIVE: To report our experience about the role of sentinel node biopsy in cervical cancer patients while debating provocatory arguments concerning this procedure. METHODS: From June 2001 to February 2003, patients affected by stage IB(1) cervical cancer were submitted to the sentinel node biopsy procedure. Patients were submitted to lymphoscintigraphy and, subsequently, to laparoscopy in order to locate the sentinel lymph node. RESULTS: Thirty-seven patients were enrolled in the study. Sentinel node(s) was(were) identified with preoperative lymphoscintigraphy in 89% of the patients. Intraoperative detection rate was 70%. During surgery in 31% of the patients, sentinel node was detected bilaterally; in 15%, two sentinel nodes on the same side of the lymphatic vessels were detected. The sentinel node was located at the level of superficial common iliac vessels (26%), external iliac vessels (69%), and superficial obturator vessels (49%). In 77% of the patients, the histologic specimen sent by the surgeon as unique sentinel node contained two or more nodes. Metastatic sentinel nodes were found in 23% of the patients. There was no case with a positive nonsentinel node in the presence of a negative sentinel node. CONCLUSION: Sentinel node detection is a feasible procedure in cervical cancer patients. However, a high percentage of patients is found with bilateral and/or more than one sentinel lymph node. Improvements in detection rate and pathological analysis are needed prior to consider the sentinel node biopsy a routine procedure in cervical cancer patients.

Paper chromatographic and paper elettrophoretic study of the solution chemistry of Tc-99m-methylendiphosphonate and of Tc-99m-dimercaptosuccinate for improving the tumour-affinity of Tc-99m during scintigraphic imaging of cancer.

In order to find the conditions under which Tc-99m-methylenediphosphonate (Tc-99m-MDP) and Tc-99m(V)-dimercaptosuccinate (Tc-99m(V)-DMSA) may become tumour-seeking agents, leaving healthy organs free from the radionuclide uptake, the solution chemistry of these radiopharmaceuticals was studied by paper chromatography and paper electrophoresis in distilled water, in physiological saline, in NAHCO3, and ascorbic acid solutions. Both radiopharmaceuticals are anionic in the radiopharmaceutical solution but get easily hydrolysed to form cationic Tc-99m species which concentrates in healthy bone and in some bone metastases. Tc-99m (V)-DMSA being more stable remains long in the blood pool giving undesirable presence of the radionuclide in lung, heart and kidneys, in addition to its reduced uptake in bone metastases and in some primaries. We are trying to eliminate these drawbacks of healthy organ uptake of Tc-99-m(V)-DMSA not only to get a clean scintigraphic image of the tumour with this radiopharmaceutical but to extend its formulation, thus obtained, to prepare radiopharmaceutical with Re-188, which is the higher homologue of Tc-99m, for systemic therapy of cancer. Essentially similar solution chemistry of both radiopharmaceuticals suggests that like Tc-99m-MDP, technetium-99m-dimercaptosuccinate is also a complex of tetravalent Tc-99m and not of pentavalent Tc-99m as so far supposed to be.