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Estimating the Risk for Secondary Cancer After Targeted α-Therapy with 211At Intraperitoneal Radioimmunotherapy.

Erik Leidermark1,2, Andreas Hallqvist1,3, Lars Jacobsson2

  • 1Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden.

Journal of Nuclear Medicine : Official Publication, Society of Nuclear Medicine
|July 7, 2022
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Summary

Intraperitoneal alpha-particle therapy (TAT) using Astatine-211 (211At) shows promise for ovarian cancer. Estimated long-term risks of secondary cancers are low, with excess mortality around 1.13 per 100 patients, suggesting the treatment is justifiable.

Keywords:
astatine-211humanradium-224secondary cancertargeted α-therapyα-particle

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Area of Science:

  • Nuclear Medicine
  • Radiation Oncology
  • Medical Physics

Background:

  • Intraperitoneal targeted alpha-therapy (TAT) using Astatine-211 (211At) is a potential adjuvant treatment for epithelial ovarian cancer.
  • Estimating long-term risks of secondary cancers is crucial for determining treatment justification, especially in patients potentially cured by primary therapies.

Purpose of the Study:

  • To estimate the long-term risks of secondary cancer and excess mortality following intraperitoneal 211At-based TAT in ovarian cancer patients.
  • To assess the overall benefit-risk ratio of this targeted alpha-therapy approach.

Main Methods:

  • Utilized published data on cancer induction and mortality from alpha-particle irradiation (224Ra, Thorotrast).
  • Applied organ dosimetry from literature to previously reported dosimetry for intraperitoneal 211At-TAT patients.
  • Calculated excess relative risk (ERR/Gy) for various organs and estimated excess mortality for a typical patient profile.

Main Results:

  • Estimated ERR/Gy varied across organs, with higher risks observed for urinary bladder, liver, kidney, and oral cavity/pharynx.
  • Total estimated excess mortality was 1.13 per 100 treated patients, with urinary bladder and kidney contributing significantly.
  • Calculated excess mortality ranged from 0.11 to 1.84 per 100 treated, depending on assumptions.

Conclusions:

  • Epidemiologic data and dosimetry enabled estimation of secondary cancer risk from 211At-based intraperitoneal TAT.
  • The estimated risk for secondary cancer is relatively low, supporting the potential justification of this therapy.
  • Reducing radiation dose to urinary organs could further decrease the risk of secondary cancers.