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Radioimmunoguided surgery.

G Veroux1, A S Nicosia, P Veroux

  • 1Institute of Surgical Pathology-University of Catania, Italy.

Hepato-Gastroenterology
|January 8, 2000
PubMed
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Radioimmunoguided surgery (RIGS) improves colorectal and ovarian cancer staging and treatment by precisely locating tumors and metastases. This molecular imaging technique enhances surgical precision, leading to improved survival rates, especially in advanced disease stages.

Area of Science:

  • Oncology
  • Molecular Imaging
  • Surgical Oncology

Background:

  • Clinical staging parameters like tumor size and lymph node involvement have limitations in predicting prognosis and guiding treatment for neoplastic diseases.
  • Molecular medicine offers complementary approaches to traditional clinical staging.
  • Accurate pre-operative staging to define the full extent of neoplasia remains a significant diagnostic challenge.

Purpose of the Study:

  • To evaluate the efficacy of radioimmunoguided surgery (RIGS) in improving the staging and treatment of colorectal and ovarian cancers.
  • To assess the impact of RIGS on survival rates in patients with different stages of colorectal cancer.
  • To demonstrate the utility of RIGS in intra-operative diagnosis and surgical radicalization for ovarian tumors.

Main Methods:

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  • Forty patients with colorectal cancer (ages 42-82) underwent pre-operative assessments including pancoloscopy, biopsies, imaging (X-ray, ECT, CT, bone scintigraphy), and echoendoscopy.
  • Patients were administered radiolabeled monoclonal antibodies (125I-B72.3 or 125I-FO23C5) for RIGS, with thyrosuppression using Lugol solution.
  • RIGS was also applied to staging and second-look procedures for ovarian tumors, with intra-operative surgical radicalization.

Main Results:

  • For colorectal cancer, 5-year survival rates were 100% for Dukes A, 85% for Dukes B (with RIGS-guided exeresis of unrecognized metastases/nodal involvement), and 64% for Dukes C (with RIGS-guided exeresis of micrometastases/isolated metastases/multicentric nodal positivity).
  • In ovarian cancer cases, RIGS aided in diagnosing fibrosis and peritoneal metastases in patients with suspicious lesions or negative CT scans, contributing to surgical radicalization.
  • RIGS successfully localized primary and metastatic lesions, determined tumor-free margins, assessed loco-regional spread, differentiated suspicious foci, detected occult tumor sites, verified radical exeresis, and guided liver metastases exeresis.

Conclusions:

  • Radioimmunoguided surgery (RIGS) is a valuable tool for enhancing the precision of cancer staging and surgical treatment, particularly for colorectal and ovarian malignancies.
  • RIGS improves the detection of occult disease and aids in achieving complete tumor resection, leading to improved patient survival outcomes.
  • The technique facilitates intra-operative decision-making, enabling targeted biopsies and radical exeresis, thereby addressing limitations of conventional staging methods.