REVIEW
Radioimmunoguided surgery for colorectal cancer An overview WOJl'lECI I RR/E71NSf.:I, MD, OLIN G TIIURSTON, MD, FRCSC. EllNl·'-T W!rNS, MD, FRCSC
ABSTRACT: Many d ifferent monoclonal antibodies used experimenta ll y and clinically are highly tumour-specific. Radiolahelling of these antibodies has been successfully accomplished. lmmunoscintigraphy of primary and metastatic ca ncers has a reported sensiti vity of 59 to 70%. However, in many stud ies, operative and h istologic confirmation is lacking. Radioimmunoguided surgery is a promising neµ, adjuncti ve technique for the surgical treatment of co lorecral cancer. Its reported sensitivity ranges between 70 and 100% anJ spec ificity between 66 and 100%. In approximately o ne-third o f patients wirh colorecrnl cancer, add itional intraoperative information concerni ng t he presence of su bclinical tumours was gained using radioimmunoguided surgery. This system ha~ the potentia l to assbt the surgeon in performing complete resection of cancer a nd decrease the loca l recurrence rate. This could be of parricular clinical importance for rcctosigmoid tumours where the repo rted loca l recurrence rate is as high as 30%. Despite the advances made, many prohlcms still need to be resolved. The important ones include: finding an antibody with high tumour specificity and at the same time rapid clearance from the blood pool and normal tissue - this would avoid the delay between monoclonal antibody injection and surgery and would make thi~ approach more easi ly accepted by the patient; and use of alterna tive isotopes for rad iolabelling. Radioimmunoguided su rgery has the poten tia l to change t he way surgery for colorectal cancer is being performed. It offers the possibility of improvement in patient survival. Can JGastrocnterol l 990;4(5):215-218
Key Words: Colorectal cancer, Monoclonal antibodies, Radioimm,moguided surgery
La chirurgie radioirnmunoguidee et le cancer recto-colique: Un aper'ru RESUME: Bon nnmbrc d'anticorps monoclonaux divers utilises exper imcnta lcmentn ct cliniquement sont hautemenr specifiques de tumeurs. Le radiomarquage de ces anticorp~ a etc realise avec succes. L'immunoscintigraphie des cancers primaircs et mcrnstatiqucs a une sens ibilire rapporrce de 59 a 70%. Dans Je nombreuses etudes, une confirmat ion operatoire et histologique fait De/>artnh'nl of .S11rgery, Cro.1., Cancer /mucr,rc. l: dmo11wn, Alh,,rw Corrcs/1ondt!ncc and rc/1rmr.~: IJr W Hrzc~111.1k1. Dcpanmcnr of S11rgcrv, Crm.1 Cwiccr lnsrirwe, 11 560 Uniwrsir;o Awnuc, EJmonwn, A/hcrw T6(; 122. Telephone (403) 492- 10?.7 Received [t1bl1carw11 March 9. 1990 Arcc/>!cd ./wie H, /990 (AN J (,ASTRc'l·NHR1ll VUL 4
N\15 Jut
Y/All\;lJST 1990
T
l Ir DFVELOPMENTOFMl)N\.X:LONAL
anrihndie~ against a variety of ,int 1gem, mcluding humnn c.m cerspecifiL antigens, holds promise of new treatment modalit1es fo r malignant d isease the ahi li t y tn lahel these antibodies with radioactive isotopes allowed the development nf external sc in tigrnphy for primary and metastatic tumours. The in vention nf portable, s1crilizahlc, gamma-detecti ng prnhes for intrnnperative u,e has m.1de clinical appl icat inn of the conLcpt of raJioimmunoguidcd surgery ross1hle. The purpose of this amclc 1s to review the scientific background of rndioimm unoguided surgery and to project future uses of t hb technique 111 colnrecrnl surgery. MONOCLONAL ANTIBODIES Tn dare, many different monoc lonal ant ihod ics have hcen developed. Most nf them :ire murinc ::intihodies. Examples of ant 1gens used for murine mnnoclornil antibody production m cl ude: n membrnne-enriched fraction of a human ca rci noma metastasis ( l ), carci noemhryonic an tigen (2) and a heta anomer of the Thomsen -Friedcnreich antigen ( 3). An in teresting concept involves the derivation of monoclonal antibodies of predetermined specifici ty using n synthetic antigen. This has hccn suc cessfully accomplished at the
2 15
toutefois Jcfaur. La ch1rurg1e radio11nmunoguidce e,r une nouvelle t1xhnique J'appomt promeucusc Jans le rraitcment ch1rurg1cnl Ju cancer rl'cto-colique. La ,cns1hil1re raprortec mc11lc cnrre 70 Ct 100% Ct la sreciticttc entrC 66 et )00%. C hez environ un tll'l'S Jes patients attcinrs Jc c.mccr rl'ctll-coltquc, la (h1rurg1e radio11nmunogu1dce permet d'obrcnir Jes donnces pcriopcratoires supplcmencaires sur la presence de tumcurs subcliniques. Ccttt: modalitc offre la poss1h1l1tc J'a1dcr le chirurgien aeffcctuer la resection (omplete Ju cancer ct pcut J1minuer le taux Jc recurrence locale. Cec1 pourrait s'avcrer d'unc import,mcc cliniqlll: particuliere pour lcs tumcurs rcctos1gmo"idicnncs, la recurrence locale pou~ant en effct attemTRt)ENTl'Rl)I Vt)L4
No 5 JUI Y/ALlt,Usr 1990
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