Monte Carlo-assisted voxel source kernel method (MAVSK) for internal beta dosimetry

A method is described for the determination of patient-specific organ beta doses given a known cumulated internal radioactivity distribution. A voxel source kernel for 90Y analogous to the point source function was simulated. Dose to each organ of interest could then be estimated by convolving the voxel source kernel with the patient's 3-D volume with known radioactivity assigned to each voxel. The dose calculation on eight organs took less than 1 min per patient using a Sun Sparc10 workstation.

Effects of radiolysis on yttrium-90-labeled Lym-1 antibody preparations

The physical half-life of 2.6 days and 2.2 MeV beta emissions of 90Y provide excellent properties for radioimmunotherapy applications. However, the clinically useful beta particles may be a source of radiation-induced damage of 90Y-labeled immunoconjugate radiopharmaceuticals during preparation or short-term storage. The stability of 90Y-labeled Lym-1 antibody was studied in standard radiopharmacy conditions to establish a formulation at which radiolysis is not a problem.

METHODS

Lym-1-21T-BAD immunoconjugate intermediate was prepared according to our standard procedure, then labeled with 90Y at 1, 2, 4 and 9.4 mCi/mg Lym-1 using 0.5 M tetramethylammonium acetate, pH 7, labeling buffer. Each mixture was challenged in diethylenetriaminepentaacetic acid to remove nonspecifically bound 90Y. The 90Y-21T-BAD-Lym-1 products were purified by centrifuged molecular sieving column chromatography. The radiochemical purity and immunoreactivity of each preparation was monitored daily by high-performance liquid chromatography (HPLC) and solid-phase radioimmunoassay, respectively, for 3 days. The preparation at 2 mCi/mg was also formulated in 4% (wt/vol) human serum albumin (HSA) overall and at 9.4 mCi/mg in five-fold water, 4 and 10% (wt/vol) HSA overall; all were monitored as above.

RESULTS

The monomeric quality and purity profile of products at 1 and 2 mCi/mg were retained (> or = 80%) as was their immunoreactivity (> or = 75%) over 3 days. The radiochemical purity and immunoreactivity of the product at 4 mCi/mg declined to 65% and 28%, respectively, by 3 days after preparation and in just 48 hr, the product at 9.4 mCi/mg had degraded to 21% in radiochemical purity with only 3% immunoreactivity. The current HPLC data and earlier published chromatographic evidence did not support a compromised radiochemical integrity of 90Y-DOTA complexes by loss of 90Y from the DOTA chelate.

CONCLUSION

Radiolysis of 90Y-labeled antibody preparations did not appear to be a problem at 90Y-21T-BAD-Lym-1 products < or = 2 mCi/mg. Human serum albumin proved to be an effective radioprotectant as the initial 100% immunoreactivity of the product at 2 mCi/mg was retained for 72 hr. The results underscore the need for appropriate formulations and dilutions of clinical doses of 90Y immunopharmaceuticals immediately after manufacture.

Direct beta measurements to determine in vivo whole-body activities of 90Sr in residents of the southern Urals: description of a new method

For 44 individuals living in areas of the Southern Urals with historical 90Sr contamination, whole-body activities of this radionuclide were investigated using a new mobile detection system. Beta-particles from 90Sr/90Y decay were measured in vivo via two proportional counters mounted in front of the forehead and above the head, respectively. In order to correct for absorption by the skin, scalp thickness was measured using ultrasonic techniques. Corrections are given with respect to self-absorption by the bone matrix and absorption by hair. A procedure is described to extrapolate from measured 90Sr activity of the skull bone to total 90Sr skeleton burden. As a result, 90Sr whole-body activities of up to 50 kBq were recorded in the selected cohort. For the same individuals, 90Sr was measured via the detection of bremsstrahlung using an established whole-body counting device. The overall results of both systems agree within 15%, but differences exceeding a factor of 2 were observed in some cases.

Biological dosimetry of bone marrow for incorporated yttrium-90

The biological response of bone marrow to incorporated radionuclides depends on several factors such as absorbed dose, dose rate, proliferation and marrow reserve. The determination of the dose rate and absorbed dose to bone marrow from incorporated radionuclides is complex. This research used survival of granulocyte-macrophage colony-forming cells (GM-CFCs) as a biological dosimeter to determine experimentally the dose rate and dose to bone marrow after administration of 90Y-citrate.

METHODS

The radiochemical 90Y-citrate was administered intravenously to Swiss Webster mice. Biokinetics studies indicated that the injected 90Y quickly localized in the femurs (0.8% ID/femur) and cleared with an effective half-time of 62 hr. Subsequently, GM-CFC survival was determined as a function of femur uptake and injected activity. Finally, to calibrate GM-CFC survival as a biological dosimeter, mice were irradiated with external 137Cs gamma rays at dose rates that decreased exponentially with a half-time of 62 hr.

RESULTS

Femur uptake was linearly proportional to injected activity. The survival of GM-CFCs was exponentially dependent on both the initial 90Y femur activity and the initial dose rate from external 137Cs gamma rays with 5.1 kBq/femur and 1.9 cGy/hr, respectively, required to achieve 37% survival. Thus, 90Y-citrate delivers a dose rate of 0.37 cGy/hr to the femoral marrow per kBq of femur activity and the dose rate decreased with an effective half-time of 62 hr.

CONCLUSION

Survival of GM-CFCs can serve as a biological dosimeter to experimentally determine the dose rate kinetics in bone marrow.

Maleimidocysteineamido-DOTA derivatives: new reagents for radiometal chelate conjugation to antibody sulfhydryl groups undergo pH-dependent cleavage reactions

We have synthesized two bifunctional derivatives of the macrocyclic chelating agent 1,4,7,10-tetraazacyclododecane-N,N',N",N"-tetraacetic acid (DOTA) equipped with maleimide groups for conjugation to reduced disulfide bonds of monoclonal antibodies. Using water-soluble carbodiimide chemistry, DOTA was coupled to L-cysteine to incorporate both a "pendant-type" carboxyl group for metal coordination and an orthogonal thiol group for protein attachment. The homobifunctional reagent 1,6-bis(maleimido)hexane was then used to introduce the maleimide functionality via a sulfide linkage to the macrocycle, and alternatively, the sulfide group was converted to a sulfone side chain. Both maleimide derivatives were conjugated to the anticarcinoembryonic antigen chimeric monoclonal antibody cT84.66 after light reduction of the mAb with dithiothreitol. In this manner, antibody conjugates were prepared which afforded near-quantitative labeling with the radiometals 111In(III) and 90Y(III) as well as quantitative immunoreactivity. Radioimmunoconjugates prepared with the sulfide and sulfone compounds exhibited relatively rapid linker-dependent radiometal loss when incubated in human serum and aqueous solutions at physiological temperature and pH. The unconjugated maleimidocysteineamido-DOTA derivatives and their Y(III) complexes were incubated in aqueous solution at 37 degrees C, and the resulting decomposition products were analyzed by HPLC and mass spectrometry. These studies revealed that the two bifunctional chelating agents underwent linker-specific cleavage reactions which were considerably faster at pH 7.4 than at pH 5.4. The chemically labile linker systems are expected to release chelated radiometal from mAb conjugates in a pH-dependent manner. This property may impart favorable tumor uptake and normal tissue clearance on radioimmunoconjugates prepared with these reagents, on the basis of the observation that many solid tumors are significantly more acidic than normal tissues.

A retrospective review of yttrium-90 synovectomy in the treatment of knee arthritis

We reviewed the case notes and X-rays of all patients with knee arthritis treated with yttrium-90 for the first time at a single institution from November 1981 to November 1995. Outcomes were assessed as 'improved' or 'not improved' by review of the case notes at 3, 6 and 12 months, and by the absence of further intra-articular (IA) steroid injections. Of the 121 knees treated, 87 had adequate follow-up information to allow an assessment of outcomes. Overall, 46% (95% CI 36-57) were improved at 12 months and 37% (95% CI 27-47) had no further IA injections (mean follow-up of 3.5 yr). Knees with osteoarthritis (OA) fared significantly worse with 10% (95% CI 0-29) vs 51% (95% CI 39-63) improved at 12 months (P < 0.05). Knees younger than 30 appeared to do better with 78% (95% CI 51-100) vs 28% (95% CI 17-45) having no further IA injections (P < 0.02). Knees with normal X-rays (Kellgren grade 0-1) did significantly better than those with more severe radiographic abnormalities (Kellgren grade 3-4), with 56% (95% CI 40-73) vs 24% (95% CI 8-40) improved (P < 0.01). Radiosynovectomy with yttrium-90 for knee arthritis appears to be of less value for patients with OA or with secondary OA changes on X-ray, and may be of more value for younger patients and those with spondyloarthropathies.

Tumour-to-normal uptake ratio of 90Y microspheres in hepatic cancer assessed with 99Tcm macroaggregated albumin

The selective delivery of a high dose of radiation to malignant hepatic tumours by infusion of non-biodegradable yttrium-90 (90Y) microspheres via the hepatic artery while sparing the non-tumorous liver parenchyma depends on the tumour-to-normal uptake ratio (T/N) of the therapeutic radiopharmaceutical. Using intrahepatic arterial technetium-99m macroaggregated albumin (99Tcm-MAA), the effect of tumour type, tumour vascularity assessed by hepatic angiography (HAG), tumour size and the degree of extrahepatic shunting on the T/N was investigated in 377 patients with hepatocellular carcinoma (HCC) and 25 patients with colorectal liver metastases. HCC was shown to have a wider range of T/N (0.2-26.5) compared with liver metastases (2.3-7.2). HCC with vascularity grade 1 on HAG had significantly lower T/N but there was no significant difference in HCC with higher vascularity grades. This confirmed that vascularity on HAG does not predict T/N. Overall there was no correlation between T/N and tumour size. Large tumours (> 20 cm) had a significantly lower T/N, probably due to necrosis in the tumour centres. A decrease in mean T/N with increasing percentages of lung shunting was observed in HCC. Determination of T/N by simulation with 99Tcm-MAA is recommended before internal radiation therapy with 90Y microspheres.

Selection of radioimmunoconjugates for the therapy of well-established or micrometastatic colon carcinoma

In order to optimize radioimmunotherapy (RAIT) as a cancer-treatment modality, it is necessary to select the appropriate radionuclide and antibody carrier. We evaluated the therapeutic potential of a single cycle of Mu-9 anti-CSAp monoclonal antibody (MAb) labeled with 3 different radionuclides, 131I, 90Y and 188Re. Intact antibodies and bivalent fragments with different blood clearance kinetics, normal organ distribution and varying tumor accretion and retention are also evaluated. Efficacy of treatment for large and small tumor burden was assessed in nude mice bearing s.c. GW-39 human colonic-carcinoma xenografts or intrapulmonary micrometastatic GW-39 colonies at the maximal tolerated dose of each agent. The magnitude and duration of myelosuppression associated with each radioantibody was considered by monitoring peripheral blood counts, marrow colony-forming unit activity and hematopoietic tissue weight. Radiation-dose estimates were calculated based on the kinetics of antibody accretion and elimination from tumor and normal tissues, and the results were correlated with tumoricidal activity and dose-limiting toxicity results. These studies, therefore, represent a detailed analysis, in a well-defined experimental tumor system, of several parameters (antibody form, radioisotope, tumor size) influencing the overall outcome of RAIT using equitoxic doses. It was found that myelosuppression is the primary dose-limiting toxicity for all radioantibodies except 90Y-F(ab')2, even though the different agents showed varied organ distribution. In a single-cycle treatment schedule of Mu-9 MAb, the 131I-labeled IgG is the radioimmunoconjugate of choice for the treatment of s.c. and intrapulmonary growth of the GW-39 human colonic-carcinoma xenograft in nude mice.

Advanced prostate cancer diagnosis and therapy with gallium-67 and yttrium-90, respectively

BACKGROUND

Androgen deprivation therapy remains so far the mainstay of advanced prostate cancer treatment. Although it improves the quality of life of the patient for some time, the disease progresses and soon it becomes hormonally unresponsive. The object of our research has been to find a systemic therapy for prostate cancer patients whose disease no longer responds to hormone therapy, radiation therapy, chemotherapy and immunotherapy.

PATIENTS AND METHODS

Thirty-one advanced prostate cancer patients with intense bone metastasis pain, bed ridden, and with permanent urinary catheter were first examined with Ga-67 and then treated with Y-90 solutions which were chromatographically and electrophoretically analysed for the presence of both cationic and anionic species of the radionuclide. The quality of life and prostate specific antigen (PSA values) values were followed for testing the success of the therapy.

RESULTS

Prostate cancer-affine Y-90 cured the advanced prostate cancer patients who regained their normal life. The uptake of the radionuclide in the primary cancer and its metastases responsible for the treatment has been confirmed by scintigraphy.

CONCLUSIONS

Prostate cancer-affine Y-90 solution, containing stable cationic and anionic species of the radionuclide, is effective in the cure of advanced prostate cancer patients.

PET-pharmacokinetics of 18F-octreotide: a comparison with 67Ga-DFO- and 86Y-DTPA-octreotide

The quantitative uptake kinetics of (2-[18F]fluoropropionyl-(D)phe1)-octreotide (I), a somatostatin (SRIF) receptor-specific tracer, was measured by PET. Conventional organ biodistribution and in vivo stabilities of the tracer as well as in vivo displacement and SRIF receptor blocking were determined. The 18F-fluorinated octreotide was compared with ([67Ga]-DFO-B-succinyl-(D)phe1)-octreotide (II) and ([86Y]-DTPA-(D)phe1)-octreotide (III). Initially, 2-10 MBq of the labeled tracers were injected into male Lewis rats bearing an exocrine pancreatic islet cell tumor. PET measurements were performed dynamically between 0 and 120 min postinjection. Organ distributions were determined 5, 15, 30, 60, and 120 min postinjection. The extent of metabolic degradation was analyzed in serial blood and urine samples as well as in homogenized samples of tumor, liver, and kidney. The uptake of (I) by the tumor was rapid (maximum accumulation at 1-2 min postinjection) and high (about 0.5 +/- 0.2% ID/g), followed by a fast and continuous release with koff = 10 +/- 2. 10(-5) s-1. The tracer was found to remain intact in vivo up to 120 min postinjection. Specific binding of (I) to SRIF receptors in the adrenals, the pancreas, and the pituitary gland was demonstrated in vivo by pretreatment and displacement experiments. Compound (II) also showed a fast uptake by the tumor. Its tumor residence half-life was longer (koff = 3.0 +/- 0.5 . 10(-5) s-1). Compound (II) was also predominantly excreted intact. One hour postinjection, the remaining activity in the blood pool was found to be bound to serum proteins. Early uptake kinetics for compound (III) were also rapid but reached only half the tumor uptake of (II). Compared to (I), the release of 86Y-activity from the tumor was slower (koff = 3.1 +/- 1.3 . 10(-5) s-1). Compared to (II), compound (III) was considerably less stable in vivo. The main critical organs for (II) and (III) are kidneys and bones, whereas (I) is predominantly accumulated in the liver. The in vivo behavior of (I) closely resembles 14C-labeled octreotide. Thus, 18F-labeled octreotide may be of interest in the quantitation and investigation of in vivo properties of somatostatin receptors by PET. However, the short residence of (2-[18F]fluoropropionyl-(D)phe1)-octreotide in tumors and its hepatobiliary excretion may complicate the interpretation of abdominal tumors.

Monte Carlo simulation of depth-dose distributions in TLD-100 under 90Sr-90Y irradiation

In this work the depth-dose distribution in TLD-100 dosimeters under beta irradiation from a 90Sr-90Y source was investigated using the Monte Carlo method. Comparisons between the simulated data and experimental results showed that the depth-dose distribution is strongly affected by the different components of both the source and dosimeter holders due to the large number of electron scattering events.

Feasibility of intracoronary beta-irradiation to reduce restenosis after balloon angioplasty. A clinical pilot study

BACKGROUND

With the aim of decreasing the incidence of restenosis after coronary balloon angioplasty, we developed a technique of intracoronary beta-irradiation using an endoluminally centered pure metallic 90Y source. The purpose of the present study was to evaluate the clinical feasibility and safety profile of this approach with a dose of 18 Gy delivered to the inner arterial surface.

METHODS AND RESULTS

Between June 21 and November 15, 1995, fifteen patients (6 women and 9 men; mean age, 71 +/- 5 years) underwent intracoronary beta-irradiation immediately after a conventional percutaneous transluminal coronary angioplasty (PTCA) procedure. The PTCA/irradiation procedure was technically feasible in all attempted cases, and the delivery of the 18 Gy dose was accomplished without complications. In 4 patients, the intervention was completed through intra-arterial stent implantation because of dissection induced by the initial PTCA. During the follow-up period of 178 +/- 17 days (range, 150 to 225 days), no complication occurred that could be attributed to radiation therapy. No aneurysm or angiographically detectable thrombus was observed in any of the irradiated arterial segments. The clinical event rate (4 of 15 patients underwent further target lesion revascularization) and the angiographic follow-up (6 of 15 patients had a > 50%-diameter stenosis at the previously treated site) did not suggest a marked impact on the expected restenosis rate.

CONCLUSIONS

This early experience demonstrates that our approach is feasible, and no side effects attributable to radiation were noted during a 6-month period of follow-up. Whether higher doses of beta-irradiation will favorably affect post-PTCA restenosis in patients must await further evaluation.

Preparation, characterisation and tumour targeting of cross-linked divalent and trivalent anti-tumour Fab' fragments

The monoclonal anti-CEA antibody, A5B7, has previously been administered to patients for radioimmunotherapy (RIT). Long circulation time and the formation of an immune response have limited therapeutic success in the clinic. Antibody fragments can be used to reduce the in vivo circulation time, but the best combination of fragment and radioisotope to use for therapy is far from clear. In this study we have compared the biodistribution of A5B7 IgG and F(ab')2 with chemically cross-linked divalent (DFM) and trivalent (TFM) A5B7 Fab' fragments in nude mice bearing human colorectal tumour xenografts. The cross-linkers were designed to allow site-specific labelling using yttrium 90 (90Y), a high-energy beta-emitter. We have also compared the above antibody forms conjugated to both 131I and 90Y. Both DFM and TFM were fully immunoreactive and remained intact after radiolabelling and incubation in serum at 37 degrees C for 24 h. Biodistribution results showed similar tumour uptake levels and an identical blood clearance pattern for F(ab')2 and DFM with high tumour-blood ratios generated in each case. However, unacceptably high kidney accumulation for both F(ab')2 and DFM and elevated splenic uptake of DFM labelled with 90Y was observed. Kinetic analysis of antigen binding revealed that DFM had the fastest association rate (kass = 1.6 x 10(5) Ms-1) of the antibody forms, perhaps owing to increased flexibility of the cross-linker. This advantage implies that DFM may be more suitable than F(ab')2 radiolabelled with 131I for RIT. TFM cleared from the blood significantly faster than A5B7 IgG when labelled with both 131I and 90Y, producing an improved therapeutic tumour-blood ratio. Kidney accumulation was not observed for [90Y]TFM, but a slightly higher splenic uptake was observed that may indicate reticuloendothelial system (RES) uptake. Overall, tumour uptake was higher for 90Y-labelled antibodies than for 131I-labelled antibodies. Because of the faster clearance, it should be possible to administer a higher total dose of 90Y-labelled TFM than IgG, which is attractive for RIT. Both A5B7 DFM and TFM, therefore, show favourable properties compared with their parent antibody forms.

Radiolytic protein surface mapping

We report that high energy beta particles may function as a means for mapping the surface of a protein. Comparable to Fe-EDTA in the presence of ascorbate and peroxide, 90Y-EDTA alone can break polypeptide backbone bonds on the surface of E. coli RNA polymerase. The two methods give very similar fragmentation patterns, although some unique fragments are produced by each. Radiolytic footprinting may prove useful for mapping proteins inside living cells, since beta-radiolysis produces reactive species up to approximately 1 cm away from the emitting 90Y.

A restoration algorithm for P-32 and Y-90 bremsstrahlung emission nuclear imaging: a wavelet-neural network approach

A novel wavelet-based neural network (WNN) filter is proposed for image restoration as required for imaging of beta emitters by bremsstrahlung detection using a gamma camera. Quantitative imaging of beta emitters is important for the in vivo management of antibody therapy using either P-32 or Y-90. The theoretical basis for the general case for M-channel multiresolution wavelet decomposition of the nuclear image into different subimages is developed with the objective of isolating the signal from noise. A modified Hopfield neural network (NN) architecture is then used for multichannel image restoration using the dominant signal subimages. The NN model avoids the common inverse problem associated with other image restoration filters such as the Wiener filter. The relative performance of the WNN for image restoration, for M = 2 channel, is compared to a previously reported order statistic neural network hybrid (OSNNH) filter. Initially simulated degraded images of known structures with different noise levels are used. Quantitative metrics such as the normalized mean square error (NMSE) and signal-to-noise ratio (SNR) are used to compare filter performance. The WNN yields comparable results for image restoration with suggested slightly better performance for the images with higher noise levels as often encountered in bremsstrahlung detection. Attenuation measurements were performed using two radionuclides, 32P and 90Y as required for calibration of the gamma camera for quantitative measurements. Similar values for an effective attenuation coefficient were observed for the restored images using the OSNNH filters (32P: mu = 0.122 cm-1, 90Y: mu = 0.135 cm-1) and WNN (32P: mu = 0.122 cm-1, 90Y: mu = 0.135 cm-1) filters with slightly higher values obtained for the raw data (32P: mu = 0.142 cm-1, 90Y: mu = 0.142 cm-1) for a 3.5-cm source size. The WNN, however, was computationally more efficient by a factor of 4 to 6 compared to the OSNNH filter. The filter architecture, in turn, is also optimum for parallel processing or VLSI implementation as required for planar and particularly for SPECT mode of detection.

EGS4 dosimetry calculations for cylindrically symmetric brachytherapy sources

Computer algorithms for electron binding correction to Compton scattering and for detailed simulation of K-edge characteristic x-ray production were incorporated into EGS4 unix version 2.0. Based on detailed modelling of the internal structures of sources, the modified version was used to calculate dose rate constants, radial dose functions, and anisotropy functions on the long axis for an 125I model 6711 source, 169Yb Type 5 and Type 8 sources, and a stainless steel clad (SS) 192Ir source. The geometry of these sources is cylindrically symmetric. Calculated results are generally in good agreement with corresponding values recommended by TG-43 and Monte Carlo results published by other authors. The influence of electron binding in Compton scattering on the calculated dose distribution for an 125I model 6711 source in water, and of different characteristic x-ray production models for 125I model 6711 and 192Ir SS sources, were also studied.

The kinetics of repair of sublethal radiation-induced damage in pig skin: studies with multiple interfraction intervals

The kinetics of the repair of radiation-induced sublethal damage (SLD) was studied for the epidermis of the pig. A total of either 7 or 14 interfraction intervals with incomplete repair was achieved by giving 28 fractions either as 7 x 2 fractions/day plus a top-up dose of 17 Gy (half tolerance) or as 14 x 2 fractions/day. The dose per fraction ranged from 1.96-4.82 Gy. A total of 9 intervals ranging from 0.17 h up to 8 h between fractions was used. The incidence of moist desquamation, as an estimate of acute epidermal response, was used as an end point to establish dose-effect relationships. The data were analyzed using either the incomplete repair model of Thames, assuming mono-exponential repair kinetics, or a modified version of the incomplete repair model, assuming bi-exponential repair of sublethal damage. Both methods of analysis allowed for the longer overnight interval between fractions. Analysis assuming mono-exponential repair gave a T1/2 of 0.74 h for the combined data, although there was a trend toward a longer half-time when only the longer interfraction intervals ( > 1.0 h) were used in the analysis. A further analysis using the modified version of an incomplete repair model gave a fast and a slow component of repair with significantly different half-times of 0.09 and 4.5 h, respectively. Varying the number of incomplete repair intervals by replacing half the number of fractions with a single half-tolerance top-up dose did not modify the kinetics of repair significantly, in terms of either the repair half-times or the proportion of repair associated with a fast and slow component. Reanalysis of data published previously for 3 and 4 fractions using the modified incomplete repair model again resulted in two components of repair, represented by the significantly different half-times of 0.17 and 3.0 h. These values were similar to those obtained from the multiple-fraction experiment. These data clearly demonstrate that an acutely responding tissue is associated with a long T1/2 for the repair of SLD which is independent of the dose per fraction. For accelerated fractionation schedules in the clinic, using multiple fractions per day, these results suggest a need to control the intervals between fractions carefully and when appropriate to reduce the total dose to avoid serious normal-tissue complications.

Somatostatin analogues for somatostatin-receptor-mediated radiotherapy of cancer

The aim of the present study was to selectively target a beta-emitter-labelled octreotide analogue to somatostatin (SRIF)-receptor-expressing tumours and to evaluate the feasibility of SRIF-receptor-mediated radiotherapy by delivering a lethal dose of radiation to the tumour. The most promising compound in a series of DTPA-coupled octreotide analogues was DTPA-benzyl-acetamido-D-Phe1, Tyr3-octreotide (SDZ413). In vitro, SDZ413 binds with nanomolar affinity to SRIF-receptors (IC50 = 4.0 nM) and inhibits growth hormone release from primary cultures of rat pituitary cells with an IC50 of 7.2 nM. Biodistribution studies with [90Y]SDZ413 demonstrated a fast and significant SRIF-receptor-specific accumulation of the labelled conjugate (tumour/muscle ratio after 24 h: 52/1). [90Y]SDZ413 was effective in the radiotherapy of SRIF-receptor-positive tumours in a nude mouse model. A single treatment with [90Y]SDZ413 led to a significant decrease (25%) of tumour mass. This effect was mediated by the intact radioligand, since treatment with [90Y]SDZ978, a derivative of SDZ413 which does not bind with high affinity to SRIF-receptors or with the unlabelled SDZ413 alone, failed to affect tumour growth. These results suggest that receptor-targeted radiotherapy with a 90Y-labelled octreotide analogue represents a new strategy for the treatment of SRIF-receptor-positive tumours that have been previously diagnosed with OctreoScan111 (pentetreotide).

Comparison of the targeting characteristics of various radioimmunoconjugates for radioimmunotherapy of neuroblastoma: dosimetry calculations incorporating cross-organ beta doses

To optimize the efficacy of radioimmunotherapy (RIT), the ideal antibody-radioisotope combinations should be used to deliver the highest tumor and the lowest normal tissue doses. In a mouse model, tumor and critical organ-absorbed doses delivered by different radioimmunoconjugates were calculated and compared. We used a Medical Internal Radiation Dosimetry (MIRD)-style mouse dosimetry model that incorporates cross-organ beta doses to make refined estimates of the radiation absorbed dose to tissues. Biodistribution data from neuroblastoma xenografted nude mice were used to estimate tumor, organ and bone marrow absorbed dose values for 90Y-3F8, 131I-3F8 and 131I-F(ab')2 fragments. Immunoreactive fractions of the radiolabeled antibodies were comparable. Although tumor uptake of the radioiodinated and radiometal labeled 3F8 was much higher than that of the radioiodinated F(ab')2 fragments (maximum percent injected dose per gram values were 39.4, 33.2 and 20.1 for 131I-3F8, 90Y-3F8 and 131I-F(ab')2, respectively), tumor to nontumor ratios were higher for radioiodinated fragments (with the exception of tumor to kidney ratio). For the minimum tumor dose necessary for complete ablation, the bone marrow received 195, 278 and 401 cGy for 131I-F(ab')2, 131I-3F8 and 90Y-3F8, respectively. Tumor doses were 50.1, 232 and 992 cGy/MBq for 131I-F(ab')2, 131I-3F8 and 90Y-3F8, respectively. Tumor to bone marrow dose, which is defined as the therapeutic index, was 21.5, 14.7 and 10.4 for 131I-F(ab')2, 131I-3F8 and 90Y-3F8. 131I-F(ab')2 fragments produced the highest therapeutic index but also the lowest tumor dose for radioimmunotherapy. Radiometal conjugated IgG produced the highest tumor dose but also the lowest therapeutic index.

Site-specific modifications of light chain glycosylated antilymphoma (LL2) and anti-carcinoembryonic antigen (hImmu-14-N) antibody divalent f1agments

Site-specific introduction of metal-chelating groups into F(ab')2 fragments of an antilymphoma antibody (LL2) possessing a natural Asn-linked light chain carbohydrate and an anti-carcinoembryonic antigen antibody (hImmu-14-N) grafted with a light chain carbohydrate site is described. For this purpose, four yttrium- (and indium)-chelating agents were used, containing a primary amino group for antibody binding and 1-(4-substituted benzyl)diethylenetriaminepentaacetic acid as the metal-chelator, separated by structurally different additional linkers. Conjugates were prepared by reacting excess chelator with oxidized carbohydrate of F(ab')2 fragments, with or without a subsequent reduction step. The conjugates, with up to an average of 5.5 chelating groups attached to a F(ab')2 fragment, were readily labeled with 90Y and 111In and were found to retain antigen-binding ability in in vitro assays. Tumor targeting was demonstrated using a 88Y-labeled hImmu-14-N F(ab')2 carbohydrate-modified conjugate. 2-Pyridyldithiopropionic hydrazide was conjugated to the carbohydrate region, and the disulfide was selectively deprotected to the thiol group, which is reactive with reduced 99mTc. These initial experiments establish that light chain carbohydrate modification of F(ab')2 is as facile as with the Fc-region carbohydrate of intact IgG, and thereby offer the possibility of designing site-specifically substituted F(ab')2 fragments with favorable pharmacokinetic properties.

Prelabeling of chimeric monoclonal antibody L6 with 90yttrium- and 111indium-1,4,7,10-tetraazacyclododecane-N,N',N",N"'-tetraacetic acid (DOTA) chelates for radioimmunodiagnosis and therapy

90Y and 111In have been attached to chimeric monoclonal antibody L6 with a bifunctional chelating agent (DOTA-peptide isothiocyanate). The bifunctional chelating agent was prelabeled with either radiometal and then conjugated to the antibody. Studies in human patients showed excellent 111In single-photon emission computed tomography images of breast cancer lesions 24 h after injection.

A displacement model for thermoluminescent dosimetry in radioimmunotherapy

A model is developed to enable dose determination for thermoluminescent dosimeters immersed in a radioactive solution such as used in radioimmunotherapy. For low energy beta emitters used in such therapy the size of the dosimeter results in a much lower light output than when irradiated with an external Cobalt-60 (60Co) beam to the same dose as delivered to the medium. The model takes the size of the dosimeter into account and hence allows calculation of the dose in the actual medium. The application to different dosimeter sizes as well as different radionuclide energies is also illustrated. Finally, the model can be extended to dose calculation in a mixed gamma and beta irradiation geometry.

Yttrium-90 chelation properties of tetraazatetraacetic acid macrocycles, diethylenetriaminepentaacetic acid analogues, and a novel terpyridine acyclic chelator

Realization of the potential of yttrium-90 for the radioimmunotherapy of cancer depends on rapid and kinetically stable chelation. Conditions were evaluated that influenced the chelation efficiency of these select chelators for yttrium-90: the macrocyclic chelators 2-(rho-nitrobenzyl)-1,4,7,10-tetraazacyclododecane-N,N',N",N"'-tet raacetic acid (nitro-DOTA); alpha-(2-(rho-nitrophenyl)ethyl)-1,4,7,10,- tetraazacyclododecane-1-acetic-4,7,10-tris(methylacetic) acid (nitro-PADOTA); 2-(rho-nitrobenzyl)-1,4,7,10-tetraazacyclotridecane- N,N',N",N"'-tetraacetic acid (nitro-TRITA); the acyclic chelator diethylenetriaminepentaacetic acid (DTPA); its analogues N-[2-amino-3-(rho-nitrophenyl)propyl]-trans- cyclohexane-1,2-diamine-N,N',N"-pentaacetic acid (nitro-CHX-A-DTPA) and 2-methyl-6-(rho-nitrobenzyl)-1,4,7- triazaheptane-N,N,N',N",N"-pentaacetic acid (nitro-1B4M-DTPA or nitro-MX-DTPA); and a novel acyclic terpyridine chelator, 6,6"-bis[[N,N,N",N"- tetra(carboxymethyl)amino]methyl]-4'-(3-amino-4-methoxyphenyl)-2,2':6',2 "- terpyridine (TMT-amine). The chelators fell into two distinct classes. The acyclic chelators, DTPA, nitro-CHX-A-DTPA, nitro-MX-DTPA, and TMT-amine, chelated instantaneously in a concentration-independent manner. Chelation efficiency was affected minimally when the concentrations of trace metal contaminants were increased. In contrast, the macrocyclic chelators, nitro-DOTA, nitro-TRITA, and nitro-PADOTA, chelated yttrium-90 more slowly in a concentration-dependent manner where efficiency was maximal only when the chelator:metal ratio was greater than 3. Their chelation efficiency diminished in a concentration-dependent fashion as the concentrations of trace metal contaminants were increased. Optimum labeling efficiencies were obtained through application of these principles.(ABSTRACT TRUNCATED AT 250 WORDS)

Skin dose calculations for uranium fuel particles below 500 microns in diameter

Two different methods for skin dose calculations, VARSKIN Mod 2 and PSS are compared for a spherical uranium fuel particle (diameter 1-500 microns) deposited on the skin. Nuclide-specific beta dose rate at different skin depths for a particle of unit activity is determined as a function of particle size. Both methods show that the effects of self-shielding must be included in the dose calculations for low and medium energy beta emitters. Skin dose rate is drastically overestimated when point source approximation is used. For high energy beta emitters (e.g., 90Y, 106Rh, and 144Pr) the volume source can be approximated as a point source. The difference in doses is then below 20% for particles up to 100 microns in diameter. The models give equal results deep in the skin (in terms of range of the beta particles). The reason is that the correction due to the diminished backscattering in air-tissue interface is insignificant at large distances. For three-dimensional sources the backscattering correction should be introduced in the VARSKIN Mod 2.

Regression models for the determination of the absorbed dose rate with an extrapolation chamber for flat ophthalmic applicators

The average surface absorbed dose rate, given by flat ophthalmic applicators (90Sr/90Y, 925 MBq) is determined in equivalent soft tissue using an extrapolation chamber with two flat parallel electrodes of variable separation; the input electrode is fixed in relation to the collector electrode of constant area. When estimating the extrapolation curve slope using a linear regression model, it has been observed that average surface dose rate values were underestimated by up to 19%, as compared to estimations of these values by means of a second degree polynomial regression model, while an improvement of up to 37% is observed in the standard error of the slope in the quadratic model, as compared to that of the linear model. With the aim of validating the results of these models, goodness of fit tests to a Normal (the Shapiro-Wilk test) as well as homogeneity tests on treatment variance (the Bartlett test) were applied. The analysis of variance (ANOVA) tables of fit and residual error breakdown are given: table 3a and 3b for linear fit; 7a and 7b for quadratic fit, and table 10 to error breakdown. Also presented is the global uncertainty of the average dose rate, taking into account the reproducibility of the experimental set-up. It may be inferred that by using this type of measurement for the extrapolation curve slope, quadratic regression models allow for a greater degree of accuracy and precision in determining surface dose rate values. The effective area of the collector electrode and the effective electrode separation in the chamber are also determined by measuring the chamber's electric capacity. Finally, there is an attempt to relate the use of the regression models to the experimental conditions during the measurement of ionization currents (diameter of collector electrode, electrical field gradient, radiation field uniformity, radiation field intensity, etc.). In this particular case, deviations in the distance inverse square law and the "screening" effects during the collection of negative charges (both for primary radiation and the ionization generated by it), are presented as necessary, but insufficient, conditions to explain thoroughly the quadratic behavior of ionizing currents.

Amelioration of both early and late radiation-induced damage to pig skin by essential fatty acids

PURPOSE

To evaluate the possible role of essential fatty acids, specifically gamma-linolenic and eicosapentaenoic acid, in the amelioration of early and late radiation damage to the skin.

METHODS AND MATERIALS

Skin sites on the flank of 22-25 kg female large white pigs were irradiated with either single or fractionated doses (20 F/28 days) of beta-rays from 22.5 mm diameter 90Sr/90Y plaques at a dose rate of approximately 3 Gy/min. Essential fatty acids were administered orally in the form of two 'active' oils, So-1100 and So-5407, which contained gamma-linolenic acid and a mixture of that oil with eicosapentaenoic acid, respectively. Oils (1.5-6.0 ml) were given daily for 4 weeks prior, both 4 weeks prior and 10-16 weeks after, or in the case of one single dose study, just for 10 weeks after irradiation. Control animals received a 'placebo' oil, So-1129, containing no gamma linolenic acid or eicosapentaenoic acid over similar time scales before and after irradiation. Acute and late skin reactions were assessed visually and the dose-related incidence of a specific reaction used to compare the effects of different treatment schedules.

RESULTS

A reduction in the severity of both the early and late radiation reactions in the skin was only observed when 'active' oils were given over the time course of the expression of radiation damage. Prior treatment with oils did not modify the radiation reaction. A 3.0 ml daily dose of either So-1100 or So-5407 given prior to, but also after irradiation with single and fractionated doses of beta-rays produced the most significant modification to the radiation reactions, effects consistent with dose modification factors between 1.06-1.24 for the acute reactions of bright red erythema and/or moist desquamation, and of 1.14-1.35 for the late reactions of dusky/mauve erythema and dermal necrosis. There was the strong suggestion of an effect produced by the 'placebo' oil, So-1129, after higher daily doses of oil.

CONCLUSIONS

Essential fatty acids can modulate normal tissue reactions when given over the time when radiation damage is normally expressed. Dose modification factors suggest that a > or = 10% higher dose is required to produce the same level of normal tissue injury. Clinical application of selected essential fatty acids at appropriate doses may lead to a significant increase in the therapeutic gain in patients treated for cancer by radiotherapy.

A facile, water-soluble method for modification of proteins with DOTA. Use of elevated temperature and optimized pH to achieve high specific activity and high chelate stability in radiolabeled immunoconjugates

We have developed a method for attachment of the macrocyclic chelating agent 1,4,7,10-tetraazacyclododecane N,N',N",N"'-tetraacetic acid (DOTA) to proteins by activation of a single carboxyl group with N-hydroxysulfosuccinimide (sulfo-NHS). The sulfo-NHS active ester of DOTA was prepared in a single step using 1-ethyl-3-[3-(dimethylamino)propyl]carbodiimide (EDC), and DOTA conjugates of cytochrome c and the anti-carcinoembryonic antigen chimeric monoclonal antibody cT84.66 were prepared by adding the DOTA active ester reaction mixture to the proteins at pH 8.5-9.0. Mass spectrometry of the cytochrome c conjugates showed that as the molar ratio of DOTA active ester to protein in the reaction mixture was increased from 10:1 to 100:1, the average number of chelators attached to the protein molecule increased from 2.64 to 8.79. When DOTA active ester reacted with the antibody at a molar ratio of 100:1, the conjugate averaged 3.8 chelates per antibody. Immunoreactivity of the antibody conjugate radiolabeled with 111In(III) and 90Y(III) remained quantitative. Variation of the DOTA:sulfo-NHS:EDC activation stoichiometry from 2:2:1 to 10:10:1 revealed that the kinetic stability of the radioconjugates increased as the molar ratio of carbodiimide, relative to DOTA and sulfo-NHS, was decreased. Radiolabeling of the protein conjugates with 111In(III) and 90Y(III) proved to be sensitive to pH, buffer, and temperature effects. The optimum pH for the labeling reaction was different for each protein and may be related to the isoelectric point of the protein. Radiometal incorporation at high specific activity was accomplished in acetate and Tris buffers, but the presence of citrate inhibited the labeling reaction. Increasing the temperature of the radiolabeling reaction from 25 to 43 degrees C greatly increased both the efficiency of radiometal incorporation and the kinetic stability of the radioconjugates. Stability studies of the conjugates in human serum and in the presence of a 5000- to 250,000-fold excess of diethylenetriaminepentaacetic acid (DTPA) demonstrated that the radiolabeled proteins are kinetically inert under physiological conditions. In serum, the 111In(III)-labeled antibody showed a rate of radiometal loss of approximately 0.08% per day. In the presence of excess DTPA, both conjugates lost 111In(III) at a rate of about 0.3% per day. No loss of 90Y(III) from the conjugates was observed in serum, but in excess DTPA, both 90Y(III) labeled proteins showed a rate of radiometal loss of approximately 0.2% per day. Therefore, kinetic analysis of metal loss from a radiolabeled immunoconjugate in the presence of a vast excess of DTPA may provide a better indication of the in vivo stability of that immunoconjugate than serum stability studies.

Continuous infusion chemotherapy as a radiation-enhancing agent for yttrium-90-radiolabeled monoclonal antibody therapy of a human tumor xenograft

Radioimmunotherapy using monoclonal antibodies is a promising investigational treatment modality for solid tumors. Use of radiation-enhancing agents could significantly impact on the therapeutic response of this treatment. We evaluated the potential interaction of a known radiation-enhancing agent, 5-fluorouracil (5-FU), with the radioimmunotherapeutic effect of a yttrium-90 (90Y)-labeled monoclonal antibody in a human adeno-carcinoma xenograft. Athymic mice were inoculated subcutaneously with the human colon carcinoma cell line LS-174T. All mice had intraperitoneal 3-day osmotic infusion pumps placed by laparotomy. Half of the pumps were filled with 0.9% saline solution and half were filled with a solution containing 5-FU. Three activity levels of 90Y-radiolabeled CC49 antibody were injected into tail veins of the mice. Each activity level was injected into a group of animals with saline-filled pumps and a group with 5-FU-filled pumps. A significant interaction between treatment group and time was found suggesting that the rate of tumor growth for the group of animals receiving 90Y at 100 microCi plus 5-FU compared to the group of animals receiving 90Y alone was significantly delayed (P = 0.0055), showing a radiation enhancing effect by 5-FU. These results suggest that the addition of the radiation-enhancing agent 5-FU to radiolabeled antibody may increase the ability to treat solid tumors. Further investigations with other antibodies, radionuclides, and tumor models are indicated.

Evaluation of the serum stability and in vivo biodistribution of CHX-DTPA and other ligands for yttrium labeling of monoclonal antibodies

Serum stability and in vivo biodistribution of both A and B isomers of the 2-(p-isothiocyanatobenzyl) (p-SCN-Bz)-cyclohexyldiethylenetriaminepentaacetic acid ligand (CHX-DTPA), a recently developed backbone-substituted derivative of DTPA, were evaluated and compared to those of 2-(p-SCN-Bz)-6-methyl-DTPA (1B4M-DTPA) and 2-(p-SCN-Bz)-1,4,7,10-tetraazacyclododecane tetra-acetic acid (2B-DOTA).

METHODS

Stability of 88Y-labeled ligands (0.1 microM) was evaluated in serum for up to 17 days. For biodistribution, ligands were conjugated to monoclonal antibody (Mab) B3, a murine IgG1k, and labeled with 88Y at 0.1-0.3 mCi/mg. Nontumor-bearing nude mice were injected intravenously with 1-2 microCi/4-10 micrograms of 88Y-labeled B3-conjugates and killed at 6 hr and daily up to 168 hr postinjection. Indium-111-(1B4M)-B3 was co-injected in all mice as internal control.

RESULTS

Serum stability of 88Y-DOTA failed to show any significant release of activity, whereas pseudo-first-order dissociation rate constants of 3.97 x 10(-3), 2.54 x 10(-3) and 1.46 x 10(-2) (day-1) were calculated for 88Y-1B4M, 88Y-CHX-A and 88Y-CHX-B, respectively. Accordingly, cortical bone uptake of 88Y was significantly higher for all DTPA-derivative chelates than for DOTA.

CONCLUSIONS

While none of the DTPA-derivative chelates could challenge DOTA in its ability to hold the radioytrium, significant differences were observed in the kinetic inertness of the A and B isomers of CHX, indicating that the CHX-B ligand is not as suitable for 90Y-labeling of Mabs.

Human recombinant TNF-alpha on localization of 90Y-radioantibody in human tumour xenografts

The effect of recombinant human tumour necrotic factor-alpha (TNF-alpha) on the intratumour and whole-body distributions of 90Y-labelled C110 anticarcinoembryonic antigen (CEA) monoclonal antibody (MAb) was studied using nude mice bearing two different tumours. The nude mice were injected subcutaneously with the CEA-positive LS174T colorectal cancer xenograft and the CEA-negative H-MESO-1 malignant mesothelioma xenograft. One hour before injection of radiolabelled MAb, mice were injected intravenously with human recombinant TNF-alpha (3 mg per mouse) or saline, and biodistributions of radiolabel were determined by tissue counting and whole-body autoradiography (ARG). Twenty-four hours after injection, TNF-alpha administration increased radioactivity in the LS174T tumour by 57% (17.30 +/- 1.61 vs. 9.83 +/- 1.55% ID g-1, P < 0.01), while decreasing radioactivity in blood and other normal organs. Diminished but similar effects on radioantibody biodistribution were seen at 48 and 72 hours. TNF-alpha did not affect specific MAb localization in the control H-MESO xenograft. Tumour:blood ratios were increased from 0.7 to 1.7 at 24 h with TNF-alpha administration. Pretreatment with TNF-alpha may be of value in increasing specific localization of monoclonal antibodies in tumour tissue.

90Y-labeled antibody uptake by human tumor xenografts and the effect of systemic administration of EDTA

PURPOSE

A human tumor xenograft model was used to compare the tumor and normal tissue uptake of a tumor-associated monoclonal antibody radiolabeled with 125I or 90Y.

METHODS AND MATERIALS

Nude mice bearing SC xenografts of the human colon adenocarcinoma, HT29, were injected with a mixture of 125I- and 90Y-DTPA-labeled AUA1 monoclonal antibody, which recognizes an antigen expressed on the surface of the tumor cells. In addition, the effect of systemic ethylenediaminetetraacetic acid (EDTA) administration on 90Y-labeled antibody clearance, tumor uptake of antibody and bone accumulation of 90Y was studied in a nude mouse model of intraperitoneal cancer.

RESULTS

Both the absolute amount (%id.g-1) and the tumor:normal tissue ratios were superior for the 90Y-labeled antibody, compared with the iodinated antibody, with the notable exception of bone. These results suggest that 90Y is a preferable isotope to iodine for radioimmunotherapy of solid masses, but that myelotoxicity, due to bone uptake of released 90Y, will limit the radiation dose which can be given when DTPA is used to chelate the 90Y. The 90Y-labeled antibody showed similar serum stability in vitro in the presence or absence of EDTA after incubation for up to 48 h. In vivo, urine excretion of 90Y was significantly enhanced in mice receiving daily injections of 20 mg EDTA for 3 days, commencing 2 h after intraperitoneal antibody administration, compared with control mice. There was no significant difference in the tumor uptake of 90Y-labeled antibody in EDTA-treated and control mice at any time-point up to 9 days postinjection. However, the bone levels of 90Y were significantly reduced in EDTA-treated mice at all times from 1 to 9 days.

CONCLUSION

Based on these results, it should be possible to increase the amount of 90Y-labeled antibody administered, by chelating the released 90Y with systemic EDTA to facilitate its excretion, without compromising tumor uptake of radiolabeled antibody.

Correlation of beta-camera imaging and immunohistochemistry in radioimmunotherapy using 90Y-labeled monoclonal antibodies in ovarian cancer animal models

Tumor stroma contains much fibrin and monoclonal antifibrin antibody targeting is possible in tumors. In this study, nude mouse human ovarian carcinoma xenograft specimens were investigated after treatment with 90Y-labeled monoclonal antifibrin antibody Fab fragment or with 90Y-labeled OC125-monoclonal antibody F(ab')2 fragments. The mice received the radioimmunotherapy activity either intratumorally, intraperitoneally, or intravenously. Beta-camera imaging (BCI) is a novel device for studying activity distribution in tissue specimens and, together with immunohistochemistry (IHC) with OC125, antifibrin, anticarcinoembryonic antigen, anti-cytokeratin, and anti-placental alkaline phosphatase antibodies, was used for correlation of activity distribution of tissue specimens. These results were in concordance: Antigen distribution measured with IHC and radioactivity distribution were similar with the same antibodies, antifibrin, and OC125: However, these antigens demonstrated rather different distribution. Tissue studies revealed that activity was concentrated also in the necrotic tumor tissue, indicating that cell death was also caused by radiation. Differences in the tumor cell morphology were observed using different routes of administration. With BCI, it is possible to quantitate activities in frozen sections (microdosimetry), and these results were in concordance with absolute activities as measured by tissue sampling and well-counting. Three-dimensional reconstruction of tissue slices combined with radioactivity distribution measured with BCI allows estimation of total absorbed radiation dose in tumor after an appropriate dose planning.

Absorbed fractions for electrons and beta particles in spheres of various sizes

The use of electron-emitting radionuclides in tumor imaging and therapy has presented some new challenges to conventional radiation dosimetry. The fraction of electron energy absorbed in most source regions has usually been assumed to be unity. In small structures such as localized tumors or isolated regions containing moderate to high energy electron emitters, however, this may not always be the case.

METHODS

Using an extension of Berger's scaled absorbed dose distributions for point sources to represent a spherical geometry, absorbed fractions of electron energy for sources uniformly distributed in spheres of various sizes have been calculated.

RESULTS

Beta particle and monoenergetic electron energies studied range from 0.025 to 4.0 MeV and sphere masses range from 0.01 to 1000 g. S values have also been calculated for 90Y, 123I and 131I based on the results of the absorbed fraction calculations.

CONCLUSION

These calculated absorbed fractions are valuable in estimating electron energy loss from small spherical structures and may be useful in estimating the radiation dose to these small volumes.

The modulation of radiation-induced damage to pig skin by essential fatty acids

The ability of essential fatty acids (EFAs) to modulate radiation-induced normal tissue injury was assessed in pig skin. Female Large White pigs (approximately 25 Kg) received 3 ml/day orally of either an 'active' oil [So-1100, containing 9% gamma-linolenic acid (GLA)] or a 'placebo' oil (So-1129) for just 4 weeks before or for 4 weeks before and for 16 weeks after irradiation; localised irradiation of skin was with single doses of beta-rays from 22.5 mm diameter 90Sr/90Y plaques. The severity of the acute reaction, assessed in terms of erythema or moist desquamation, was significantly less in those pigs that received So-1100 both before and after irradiation, as compared with those receiving that oil only prior to irradiation and the 'placebo' groups. Dose modification factors (DMFs) of between 1.13-1.24 were obtained. A similar reduction in the severity of acute skin injury was seen in pigs receiving So-1100 for only 10 weeks after irradiation. Late skin damage, assessed in terms of late erythema or dermal necrosis, was also reduced with So-1100, with DMFs of 1.14-1.51. No such modification was observed if So-1100 was only administered for 4 weeks prior to irradiation. No adverse side-effects were apparent as a result of EFA administration. So-1100 may represent a safe and valuable method of increasing the therapeutic gain in radiotherapy.

Evaluation of indium-111- and yttrium-90-labeled linker-immunoconjugates in nude mice and dogs

Rapid uptake and slow transit of radioactivity from normal organs are detrimental to any clinical utilized radioimmunoconjugate because they lower the target-to-nontarget ratio and deliver undesirable radiation to normal organs. To mitigate this problem, two labile chemical linkages (EGS and DST) were introduced between a monoclonal antiferritin antibody (QCI) and a chelating agent (DTPA). The biodistribution of labile-linker immunoconjugates (EGS and DST) and stable linker immunoconjugates (DSS and ITCB) were compared. In a nude mouse model, all of the four immunoconjugates labeled with 111In targeted subcutaneously-implanted human tumor cells. Tumor-to-normal organ ratios were enhanced for the EGS linkage in comparison to the two stable linkages. Serial whole-body immunoscintigraphy confirmed the biodistribution study. The EGS and ITCB 90Y-labeled immunoconjugates had biodistributions similar to their respective 111In-labeled immunoconjugates. As the mouse model is not representative of the high uptake of monoclonal antibodies in the human liver, beagle dogs were used to further explore the retention of radiolabel in normal liver. The EGS-linked immunoconjugate significantly reduced the dog liver activity when compared to the ITCB immunoconjugate. The combination of the animal models (mouse and dog) appears to allow for a more compete and optimal preclinical analysis of chelated radiolabeled monoclonal antibodies for diagnosis or treatment and illustrates the potential clinical improvements possible with labile chemical linkages in radioimmunoconjugates.

Efficacy and safety of radiation synovectomy with Yttrium-90: a retrospective long-term analysis of 164 applications in 82 patients

In this long term retrospective study of radiation synovectomy with Yttrium-90 (Y90), we evaluated the results of 164 applications in 82 patients with RA, OA with synovitis, ankylosing spondylitis and psoriatic arthritis. Radiation synovectomy with Y90 has an overall success rate of approximately 50% and is therefore an effective alternative to surgical synovectomy in chronic synovitis which fails to respond to conservative treatment. Elbow and knee responded significantly better than shoulder and ankle joints. Patients with radiological stages from 0 to 2 showed a significantly better success rate than those with stage 3 changes. In responders, repeat therapy for recurrence of symptoms or treatment of a symptomatic corresponding symmetrical joint is advisable. Repeat therapy in a previous non-responder is associated with an unacceptably high failure rate. Therefore, when a joint fails to respond after 6 months, arthroscopy should be performed to evaluate further treatment procedures. A successful result was found in only 11 of 25 joints treated with arthroscopic synovectomy followed by radiation synovectomy within 2 weeks, indicating no benefit of this combination.

Zero tumor incidence in mice after repeated lifetime exposures to 0.5 Gy of beta radiation

A final series of experiments on tumor induction by repeating 90Sr-90Y beta irradiation of the back of ICR mice three times weekly throughout the life span showed no tumor incidence with repeated doses of 0.5 Gy per exposure. The whole dose-response relationship for repeated irradiation with 0.5 to 11.8 Gy per exposure, summarized along with data obtained previously, showed a unique nonlinear dose response with saturation of tumor incidence at doses of over 2.5 Gy per exposure and a threshold-like value around 1.5 Gy per exposure.

Yttrium 90-labeled antiferritin followed by high-dose chemotherapy and autologous bone marrow transplantation for poor-prognosis Hodgkin's disease

PURPOSE

This study was undertaken to examine the feasibility of combining radiolabeled antibody therapy with high-dose chemotherapy followed by autologous bone marrow transplantation in patients with poor-prognosis Hodgkin's disease.

PATIENTS AND METHODS

Patients were entered onto this protocol if they had chemotherapy-resistant disease, bulky disease, or extensive prior therapy. Patients received yttrium-labeled antiferritin on day -13, -12, or -11, followed by high-dose cyclophosphamide, carmustine, and etoposide (CBV) on days -6 to -3, and then bone marrow infusion on day 0.

RESULTS

Twelve patients received both radiolabeled antibody and high-dose chemotherapy followed by autologous transplantation. Two additional patients started the study, but were unable to complete all therapy. Four of 12 patients experienced early transplant-related mortality. Four patients are alive more than 2 years following transplantation and three are free from disease progression at 24+, 25+, and 28+ months following transplantation. The progression-free survival rate at 1 year is estimated to be 21%. Considering the poor prognostic characteristics of these patients, toxicity on this protocol was not necessarily greater than that observed with high-dose chemotherapy alone.

CONCLUSION

This report demonstrates the feasibility of combining radiolabeled antibody therapy with high-dose chemotherapy and autologous bone marrow transplantation.

Dose- and source-size-related changes in the late response of pig skin to irradiation with single doses of beta radiation from sources of differing energy

Late radiation damage to pig skin has been assessed at 104 weeks after exposure to sources of 90Sr/90Y (Emax 2.2 MeV) and 170Tm (Emax 0.9 MeV). Damage was assessed from measurements of dermal thickness in histological sections of irradiated skin and was compared with that of unirradiated skin to establish the relative reduction in dermal thickness. The size of the source varied from 0.1 to 40.0 mm in diameter; this covered the range of source sizes designed to simulate exposure to radioactive "hot" particles (< or = 1.0 mm diameter) up to the lower range of field size that patients may be exposed to in radiotherapy treatments. Radiation doses were measured using an extrapolation chamber with a collecting electrode of 1.1 mm2, and thus the quoted doses represent an average dose over this area. For the larger 90Sr/90Y sources of > or = 5 mm diameter and the larger 170Tm sources of > or = 2 mm diameter there was no evidence, based on levels of damage consistent with a > or = 10, > or = 20, > or = 30, and > or = 40% reduction in relative dermal thickness, for any effect of source size on the ED50 value for each of these specified levels of effect. However, there was a marked effect of beta-particle energy; the skin surface doses associated with the ED50 values (+/- SE) for a > or = 20% reduction in relative dermal thickness were approximately 12 and approximately 40 Gy for 90Sr/90Y and 170Tm, respectively. This difference in skin surface dose for an equivalent level of dermal injury reflects the variation in the depth dose from these two beta-particle emitters. These skin surface doses, for what was considered to be a clinically detectable dermal effect, were below the ED10 for the early skin response of moist desquamation. This supports the selection of late dermal thinning as the effect on which to base dose limits in radiation protection for more generalized larger area skin exposures. In comparison, single exposures to a small area, from sources designed to simulate those from hot particles, reinforced the view that acute ulceration should be the effect on which dose limitation is based. Either the isoeffect doses for a clinically detectable reduction in relative dermal thickness of > or = 20%, following a single exposure to a small area, were higher than the ED10 for acute ulceration or the area of skin showing dermal thinning was so small that it was not considered to be detrimental.

Endoscopic use of Nd:YAG laser to remove Marlex strut from Kock continent urinary reservoir

A Marlex strut, which was designed to prevent efferent valve prolapse and peristomal herniation in the Kock continent urinary reservoir, eroded through the pouch wall, resulting in persistent bacteriuria and the inability to catheterize the pouch. The eroding strut was removed endoscopically with the Nd:YAG laser. Continence has been preserved and ease of catheterization restored.

Prolongation of graft survival in primate allograft transplantation by yttrium-90-labeled anti-Tac in conjunction with granulocyte colony-stimulating factor

High-affinity IL-2 receptors are expressed by T cells activated in response to foreign histocompatibility antigens but not by normal resting T cells. To exploit this difference in IL-2R expression, anti-Tac, a murine monoclonal antibody specific for the IL-2R alpha subunit, was used to inhibit organ allograft rejection. To enhance its effector function, anti-Tac was armed by chelation with yttrium-90, a pure beta-emitting radionuclide. Animals received no immunosuppression (n = 5, group I, controls), unmodified anti-Tac (n = 5, 1 mg/kg q.o.d., group II), or 90Y-anti-Tac (n = 5, 1.6 mCi/kg divided into four doses, group III). The animals in group IV (n = 4) were treated identically to those in group III with the exception that 5 micrograms/kg/dose of granulocyte colony-stimulating factor was administered intramuscularly on the days when the yttrium-90 was given and on postoperative days 12 through 35 in order to reduce hematopoietic toxicity. Mean graft survival +/- S.E.M. for the control group was 8.2 +/- 0.5 days as compared with 13.8 +/- 2.1 days (P < 0.05) for those monkeys treated with unmodified anti-Tac. Graft survival was further prolonged in animals of group III that received 90Y-anti-Tac, with a mean graft survival of 45.0 +/- 11.8 days; however, three of the five monkeys retained viable grafts within this group but died secondary to bone marrow suppression. In comparison, the monkeys in group IV that were treated with G-CSF in conjunction with 90Y-anti-Tac had a mean graft survival of 49.2 +/- 2.9 days. In contrast to group III there were no deaths in the group (IV) receiving G-CSF. Furthermore, animals in group IV had a reduced magnitude and shortened duration of irradiation-induced neutropenia when compared with that observed in group III animals that did not receive G-CSF. Thus, treatment with 90Y-anti-Tac in conjunction with G-CSF may have potential applications in organ transplantation and the treatment of IL-2 receptor-expressing neoplastic diseases.

Clonal origin of skin and bone tumors produced by repeated beta-irradiation in mosaic cell mice

Clonal origin of skin and bone tumors produced by repeated beta-irradiation was determined by using mice with cellular mosaicism created by random X-chromosome inactivation, on the basis of phosphoglycerate kinase-1 (PGK). The backs of female C3H/He (Pgk-1a/Pgk-1b) mice were exposed to beta rays from 90Sr-90Y at a dose of 3 Gy per exposure 3 times weekly until tumors appeared. The cumulative tumor incidence reached 100% 500 days after the beginning of irradiation, as determined by the Kaplan-Meier method. All 8 tumors examined were of a single PGK phenotype: 5 squamous cell carcinomas and 2 osteosarcomas of A-type, and 1 squamous cell carcinoma of B-type. The absence of double PGK phenotype (AB-type) tumors indicated the monoclonal origin of the tumors produced by repeated irradiation.

Intratumoral and whole-body distributions of C110 anti-carcinoembryonic antigen radioimmunotoxin after intraperitoneal and intravenous injection: a quantitative autoradiographic study

The intratumoral and whole-body distributions of 90Y-labeled C110 anticarcinoembryonic antigen immunotoxin after i.p. and i.v. injection were compared by quantitative autoradiography. During in vitro incubation of spherical tumor nodules of LS174T human colon cancer (about 5 mm in diameter) in a medium containing C110 radioimmunotoxin (RIT), the direct penetration of the immunotoxin increased with time but was limited to the outer 300 microns of the tumor nodule after 12 h of incubation. In vivo experiments were performed in nude mice bearing LS174T xenografts as i.p. tumor nodules. Injection of C110 RIT i.p. resulted in a ring-like distribution, i.e., high uptake at the tumor periphery and considerably lower uptake at the tumor center (ratio of peripheral to central concentration, 7:1 at 1 day and 2:1 at 5 days). In contrast, i.v. injection provided a much smaller gradient in C110 RIT distribution from peripheral to central regions (ratio of peripheral to central concentration, 3:1 at 1 day and 1:1 at 5 days). Estimates of total tumor uptake of C110 RIT by quantitative autoradiography demonstrated almost equivalent tumor uptake after either i.p. or i.v. injection, while i.v. injection was associated with increased C110 RIT uptake in various normal organs, especially in the liver, as compared to i.p. injection. The results in this study suggest that (a) i.v. injection may produce more homogeneous distribution of C110 RIT in i.p. tumor nodules of LS174T but may also result in increased liver toxicity, and (b) i.p. injection may decrease C110 RIT exposure of normal tissues, which can reduce systemic toxicity, but may also produce more restricted intratumoral distribution of C110 RIT. In addition, current methods using a nude mouse model of i.p. tumor nodules and quantitative autoradiography allow us to assess intratumoral and whole-body distributions of radiolabeled immunoconjugates from various administration routes.

Chronic exposure to ionizing radiation as a tumor promoter in mouse skin

We have tested chronic exposure to 90Y beta radiation for its action as a complete tumor promoter, a stage I tumor promoter, or a stage II tumor promoter in SENCAR mouse skin. In skin initiated with a single application of 7,12,dimethylbenz[a]anthracene (DMBA, 10 nmol), chronic exposure to beta radiation as a complete promoter (0.5 Gy, twice/week, 13 weeks) produced no tumors and, when added to a complete chemical promoter (TPA), reduced tumor frequency about 30%. A similar result was observed when beta radiation was tested as a stage II promoter. DMBA-initiated mice that received chemical (12-O-tetradecanoylphorbol-13-acetate, TPA) stage I promotion followed by 13 weeks of beta-radiation exposure (0.5 Gy, twice/week) as stage II promotion produced essentially no tumors, and combining the same chronic beta-radiation exposure with chemical (mezerein) stage II promotion reduced tumor frequency about 20% when compared to a similar group that was not irradiated. Chronic beta-radiation exposure was tested two ways as a stage I tumor promoter in initiated skin that was subsequently treated with mezerein as a stage II promoter. Stage I promotion was shown to proceed with the passage of time, indicating this process occurs naturally in the absence of chemical or physical stimulation. Hyperthermia, previously shown to be a potent inhibitor of chemically stimulated stage I promotion, had no effect on the natural process, indicating at least some differences in mechanism between the two processes. The natural process was, in fact, inhibited by chemical tumor promoters, but not by radiation. In addition to the increase resulting from this natural process, tumor frequency was further increased slightly but significantly (12-15%, P less than or equal to 0.05) when chronic radiation exposure was given as a stage I promoter (0.5 Gy, twice/week, 13 weeks) subsequent to initiation, in spite of the expected 20% reduction resulting from this dose. Exposure of initiated animals to radiation (0.5 or 1.0 Gy, twice/week, 2 weeks) in addition to TPA as stage I promotion produced a similar increase in tumor frequency (P less than 0.02). At higher radiation doses, however, tumor frequency was reduced compared to unirradiated controls. In a third test as a stage I promoter, beta radiation (0.5 Gy twice/week, 4 weeks) was given prior to initiation with N-methyl-N'-nitro-N-nitrosoguanidine in animals subsequently promoted by TPA (twice/week, 13 weeks), and again the radiation slightly but significantly (P less than 0.03) increased tumor frequency compared to the unirradiated control group.(ABSTRACT TRUNCATED AT 400 WORDS)

Investigations of N-linked macrocycles for 111In and 90Y labeling of proteins

To simplify the synthesis of macrocyclic chelators, commercially available macrocyclic amines were condensed with halogenated acetic acid to prepare the five chelators 12N4 (DOTA), 14N4 (TETA), 15N4, 9N3 and 12N3. Only 12N4 and 9N3 showed efficient labeling of the free chelator with 111In and 90Y. Serum stability studies at 37 degrees C with In-labeled DTPA, 12N4 and 9N3 showed no loss of label over 2 days whereas, with 90Y, only 12N4 showed stabilities comparable to DTPA. The 12N4 chelator was derivatized by attaching biotin on one N-acetate group to stimulate the attachment to protein. The serum stability for both 111In and 90Y was identical to that of biotin derivatized DTPA and lower than that of the free chelators. Biodistribution studies in normal mice of a model protein (avidin) labeled with 90Y via biotinylated 12N4 and biotinylated DTPA showed identical distribution at 1 day except in bone where the %ID/g for the macrocyclic-conjugated protein (3.4 +/- 0.5, N = 8) was significantly (P less than 0.001) lower than that of the DTPA-conjugated protein (9.4 +/- 0.9, N = 7). In conclusion, macrocycles may be readily synthesized from the macrocyclic amines and several show useful stabilities with In and Y. When N-linked to a protein, the Y biodistribution was found to be superior to that of the corresponding DTPA-coupled protein.

The spatial and energy dependence of bremsstrahlung production about beta point sources in H2O

A Monte Carlo simulation was performed to characterize the spatial and energy distribution of bremsstrahlung radiation from beta point sources important to radioimmunotherapy (RIT). Using the EGS4 Monte Carlo code, the isotropic emission and transport of monoenergetic 0.1-, 0.5-, 1.0-, 2.0-, and 3.0-MeV electrons and 32P and 90Y beta particles was simulated in an infinite, homogeneous H2O phantom. The probability of bremsstrahlung production for each Monte Carlo-simulated electron step was accumulated in energy intervals not exceeding 5 keV and stored as a function of radial position. To validate this scheme, the EGS4 code was tested in the continuous slowing down approximation (csda) mode, with resulting radiation yields seen to agree with values in ICRU Report No. 37 (ICRU, Bethesda, MD, 1984) to better than 1.6%. The radiation yield calculated with the simulation of secondary particles is seen to be 3%-5% greater than the csda yield. The photon energy distributions are characterized by a typically broad bremsstrahlung spectrum with the probability of photon generation decreasing with radial distance. In the energy range 0.05-0.511 MeV, the probability for bremsstrahlung production from 90Y (2.76 x 10(-2) decay-1) is twice that from 32P (1.35 x 10(-2) decay-1). When passed through 10 cm of H2O and put upon a standard NaI scintillation camera, count rates of 2.3 x 10(-6) and 1.2 x 10(-6) counts s-1 Bq-1 are estimated from point sources of 90Y and 32P. These results predict the inherent spatial resolution limitation and provide the initial data required for modeling and analyzing the scatter, attenuation, and image formation processes in quantitative imaging of bremsstrahlung for RIT dosimetry.

Calibration of ophthalmic applicators at NIST: a revised approach

A revised approach to the problem of measuring a surface-absorbed dose from beta-particle-emitting ophthalmic applicators is presented. The technique chosen employs an extrapolation chamber equipped with a 4-mm-diam collecting electrode to make current measurements at air gaps from 0.08 to 0.20 mm at 0.02-mm intervals. These data yield a linear relationship between current and air gap, the slope of which is used to determine average surface-absorbed-dose rate over the central area of the source. For additional information about the distribution of the activity over the source surface, autoradiographs using calibrated radiochromic dye films are analyzed to map the dose-rate profile across the surface of the applicator. Experiments varying several parameters of the extrapolation chamber measurement, including collecting electrode area, voltage gradient, range of air gaps used, and entrance foil material, are described. Also treated are calibrations of, and a description of the use of, radiochromic dye films for source profiling. Experiments for determining correction factors for the extrapolation chamber measurements are described, and an assessment of the uncertainties associated with these measurements is given.

Radiobiologic studies comparing Yttrium-90 irradiation and external beam irradiation in vitro

The purpose of this study was to compare the effectiveness of Yttrium-90 (Y-90) labeled antibody irradiation to 60Co external beam irradiation in vitro by colony formation assay. Two human colon carcinoma cell lines, LS174T, a high CEA producer, and WiDr, a low CEA producer, were exposed to specific activities of Y-90 labeled murine monoclonal anti-CEA antibody ranging from 2.5 to 30 microCi/ml for a fixed period of time. This resulted in calculated doses of 2.25 to 27 Gy and initial dose rates of 2.5 to 29 cGy/hr. Results were compared to similar doses of Y-90 labeled non-specific antibody, unlabeled specific and non-specific antibody, and 60Co external beam irradiation. External beam irradiation studies showed that WiDr, compared to LS174T, was more radioresistant with a larger shoulder to the survival curve, indicating a greater capacity for radiation-induced sublethal damage repair. WiDr was also more radioresistant to Y-90 antibody irradiation. When compared to external beam irradiation, Y-90 labeled antibody irradiation resulted in less cell killing by a factor of 2.4 for LS174T and 3.4 for WiDr. Unlabeled antibody had no significant effect on cell survival. Radiation-induced cell cycle delay experiments demonstrated that WiDr had less cell cycle delay (0.9 to 1.0 min/cGy) compared to LS174T (1.2 min/cGy) after single fraction external beam irradiation. Our results indicate that Y-90 low dose-rate irradiation is radiobiologically less effective in vitro than high dose-rate external beam irradiation by a factor of about 2.4 to 3.4. The results also suggest that the magnitude of this difference depends on the cell line's ability to repair sublethal radiation damage and the degree of cell cycle prolongation after irradiation.