The Evolution of Radionanotargeting towards Clinical Precision Oncology: A Festschrift in Honor of Kalevi Kairemo

Radionanotargeting and Precision Radiotherapy Planning in Patients with Breast Cancer

Author(s): Pavel Krzhivitskiy*, Sergey Novikov, Sergey Kanaev and Petr Krivorotko

Pp: 79-90 (12)

DOI: 10.2174/9781681088655122010009

* (Excluding Mailing and Handling)


Purpose:Through this work dedicated to the study of molecular imaging
capabilities for radiotherapy planning in patients with breast cancer, we would like to
acknowledge our gratitude and pay respect to one of the most prominent world-class
researchers in nuclear medicine, Kalevi Kairemo. Materials and Methods: In this
retrospective study, we present our experience of molecular imaging in more than
1,800 women with breast cancer. Participants underwent Mammoscintigraphy/Breast
molecular imaging with 99mTc-MIBI for detection of multicentric (MC) breast cancer
and SPECT-CT imaging for the diagnosis of multiple (>2) metastatic axillary lymph
nodes involvement. In order to evaluate the variability of SLNs localisation and
determine how this data may influence the efficacy of the above-mentioned therapeutic
strategy, we retrospectively analysed the results of SPECT-CT examinations with
99mTc labelled nanocolloids. All of these findings were evaluated according to impact
for subsequent individual radiotherapy planning. Results: We found out that
sensitivity, specificity and accuracy of Scintimammo-graphy/Molecular breast imaging
(SMG/MBI) with 99mTc -MIBI in the diagnosis of multicentric breast cancer (MC)
was 84.3%, 98% and 96.3%, respectively. More of that, the sensitivity of SMG was
significantly superior to ultrasound (52.3%) and mammography (54.0%). This
advantage was more evident in women with dense breasts. Nowadays, we routinely use
SMG/MBI for selecting the best candidates for conservative surgery and postoperative
partial breast irradiation. An accurate diagnosis of metastases in regional lymph nodes
(LN) can significantly affect the radiotherapy strategy. The prospective evaluation of
SPECT-CT with 99mTc -MIBI in 184 primary patients with early breast cancer
indicates high sensitivity (94%-96%) of SPECT-CT in the diagnosis of extensive (more
than 2 metastases) axillary LN invasion. In these patients, additional SPECT-CT
visualisation of individual lymph flow pattern with 99mTc-nannocolloids can be
effectively used for 3D planning of simultaneous whole breast and sentinel lymph
nodes irradiation. Conclusion: Our accumulated experience in using SMG/MBI and SPECT-CT imaging
with tumor-seeking and nanocolloids radiopharmaceuticals 99mTc labelled provides a
high informative value and broad usability perspectives in developing cutting-edge
radiotherapeutic methods in patients with early and regional breast cancer.

Keywords: Breast Cancer, Lymphatic Mapping, Metastatic Lymph Nodes, Molecular Breast Imaging, Radionanocolloids, Radiotherapy Planning, Scintimammography, Sentinel Lymph Nodes, SPECT-CT.

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