SNM 2009:放射性貼片有效治療皮膚癌


  June 22, 2009 (多倫多) — 根據發表於核子醫學協會第56屆年會的資料,運用具有放射治療活性的貼片可以有效取代手術來治療皮膚癌。
  
  在一個先驅研究中,新德里的全印度醫學科學研究中心研究者探討一個磷-32皮膚貼片治療基底細胞癌的效果。主要研究者、核子醫學科放射技術員Priyanka Gupta發表本研究。
  
  Gupta小姐形容基底細胞癌為最無侵犯性的皮膚癌,但是,依據不同病灶部位,醫師可能難以用手術移除。
  
  手術可能有一些缺點,例如難以手術的部位,或者腫瘤位於多處導致術後難以進行移植。
  
  Gupta小姐表示,放射治療對病患的缺點是,需要回診多次,可能對鄰近的健康組織造成傷害。
  
  總共有8名病患(4名男性與4名女性)參與本研究,年紀從45至74歲(平均年紀57.25歲),全都診斷有位於臉部的單一病灶基底細胞癌,且以組織學確認。這8個病患中,4個人的病灶靠近眼睛,3個人的病灶在鼻子,1個人的病灶在前額。沒有病患的病灶擴散到其他構造。
  
  這種密封型貼片,可以1mCi/cm2的濃度遞送放射性磷-32,可以適合各種大小與形狀的病灶。在病灶上使用貼片3小時。之後在第4或5天使用貼片,在第7或8天再度使用;每次都使用3小時。
  
  Gupta小姐在Medscape Radiology的訪問中表示,因為這是此類型的首次研究,我們選擇只有1個病灶的病患。其他排除規範為小於18歲;血液、腎臟或肝臟異常病史;哺乳或懷孕。
  
  Gupta小姐指出,在使用前需檢查貼片,以確認沒有放射線外漏。
  
  治療之後在各種時間點進行臨床檢查,以評估治療結果,研究者在治療後3個月進行切片檢查。
  
  Gupta小姐在發表時表示,所有案例中,皮膚科醫師檢查指出病灶變平了。所有案例的切片發現殘餘惡性疾病為陰性。
  
  研究者每3個月為病患進行血液與生化檢查,並未發現病患有毒性徵兆。
  
  Gupta小姐指出,磷是用於貼片的適當選擇,因為它不會釋放伽馬射線。
  
  德國PET中心主任、核子醫學診所主任、核子醫學教授Richard P. Baum博士表示,需要大型的研究來確認此一方法是否和基底細胞癌的標準治療一樣有效,甚至更好。
  
  Baum博士表示,效果看來非常好。但由於研究對象只有一小組病患,為了判斷它是否可以取代手術或放射線治療,我們需要以更多病患進行比較研究。Baum博士建議,進行手術、體外放射線、磷-32皮膚貼片的比較研究。
  
  Baum博士指出,雖然研究者在病患的例行檢查中未發現毒性,必須更進一步研究,以排除任何可能的放射線吸收。
  
  Baum博士表示,是不太可能從貼片外漏,但是我有興趣研究血中的放射線程度,以便確認。
  
  Gupta小姐與 Baum博士都宣告沒有相關財務關係。
  
  核子醫學協會(SNM)第56屆年會:摘要158。發表於2009年6月15日。
  

SNM 2009: Radioactive Patch Effectively Treats Skin Cancer

By Louise Gagnon
Medscape Medical News

June 22, 2009 (Toronto, Ontario) — The application of a skin patch that delivers radiotherapy can be an effective alternative to surgery to treat skin cancer, according to data presented here at the Society of Nuclear Medicine 56th Annual Meeting.

In a pilot study, investigators at the All India Institute of Medical Sciences in New Delhi looked at the effect of a phosphorus-32 skin patch to treat basal cell carcinoma. Findings were presented by Priyanka Gupta, BSc, PGDM, MSc, the study's principal investigator and a radiation technologist in the Department of Nuclear Medicine.

Ms. Gupta described basal cell carcinoma as the least aggressive skin cancer, but she noted that, depending on the site of the lesion, it can be challenging for clinicians to remove the lesions surgically.

"Surgery can have some disadvantages, such as [when] it is difficult to operate at the site of the tumor or is in patients with tumors at multiple sites [making] grafting after a surgical operation [difficult]."

The downside of radiotherapy for patients is that it might require multiple visits to a clinic, and there might be a strong potential for damage to neighboring healthy tissue, said Ms. Gupta.

A total of 8 patients (4 men and 4 women) participated in the study. They ranged in age from 45 to 74 years (mean age, 57.25 years). They had all been diagnosed with unifocal basal cell carcinoma on the face that was confirmed on histology. Of the 8 patients, 4 had lesions that were proximal to the eye, 3 had lesions on the nose, and 1 had a lesion on the forehead. No patients had lesions that spread to underlying structures.

The sealed patches, which delivered radioactive phosphorus-32 containing 1?mCi/cm2, were designed to fit the size and shape of the individual lesions. The patches were applied over the lesions for 3 hours. The patches were reapplied on day 4 or 5 and again on day 7 or 8 after the initial application; each application was for 3 hours.

"Since this is the first study of its kind, we chose patients who only had 1 [lesion]," Ms. Gupta said in an interview with Medscape Radiology. Other exclusion criteria were age less than 18 years; a history of blood, renal, or liver disorders; and breast-feeding or pregnancy.

The patches were checked for any possible leakage prior to application, noted Ms. Gupta.

Clinical examinations were done at various time points after the treatment to assess healing, and investigators performed biopsies 3 months after treatment.

In all cases, the examining dermatologists noted that there had been flattening of the lesions, Ms. Gupta said during an oral presentation. The biopsies were negative for residual malignant disease in all cases.

The investigators conducted hematologic and biochemical examinations of patients periodically over 3 months. They observed no signs of toxicity in patients.

Ms. Gupta pointed out that phosphorus is an appropriate choice for the patch because it does not release gamma radiation.

A larger patient sample is needed to determine if this management approach is comparable or superior to standard treatment of basal cell carcinoma, said Richard P. Baum, MD, PhD, professor of nuclear medicine, chair of the Clinic for Nuclear Medicine, and head of the Center for PET at Zentralklinik in Bad Berka, Germany.

"The efficacy appears to be very good," said Dr. Baum. "It is a small group of patients. To see if it is an alternative to surgery or radiotherapy, we need to conduct a comparative study with more patients." Dr. Baum suggested a comparative study of outcomes with surgery, external-beam radiation, and radiation delivered by the phosphorus-32 skin patch.

Although the investigators found no toxicity in routine monitoring of patients, they need to go a step further to rule out any possible radiation absorption, added Dr. Baum.

"It's unlikely that there was leakage [from the patch], but I would have been interested in looking at radioactivity levels in the blood just to be sure," said Dr. Baum.

Ms. Gupta and Dr. Baum have disclosed no relevant financial relationships.

Society of Nuclear Medicine (SNM) 56th Annual Meeting: Abstract 158. Presented June 15, 2009.
J Nuclear Med. 2009;50(suppl 2):41P.

    
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