“After more than 12,000 lymphoscintigraphies, we missed the sentinel node in only 99 cases”

“After more than 12,000 lymphoscintigraphies, we
missed the sentinel node in only 99 cases”
Along with Veronesi, he knows only too well the

struggle to get new therapeutic approaches accepted

by insurance – asmany as half of women in theUS

still have amastectomy instead of breast conserving

treatment. I think this is the best idea I’ve had inmy

career so far.”

The next stepwill be to add an antibody specific

to breast cancerwith the avidin, but this is not ready

for trial yet. The technique without the antibody is

known as IART – intraoperative avidination for

radionuclide therapy – andPaganelli says, after successful

completionof the present trial, it should go to

a multicentre study this summer. There are several

other techniques to accelerate breast irradiationcurrently

in trial, but none that are as simple to apply as

IART(seeClinCancerRes13:5646s–5651s), andhe

would like to extend the idea to other cancerswhere

conventional radiotherapy can have major sideeffects,

such as in the head and neck.

It is another chapter in the now very lengthy

story of breast conserving treatment, and Paganelli,

alongwithVeronesi of course, knows only toowell the

struggle to get newtherapeutic approaches accepted

– and bureaucracy in Italy is a particularly tough nut

to crack. He also anticipates running up against

vestedinterests. “I’msure themakers of linacswillnot

be so happy – but in fact if you cut the number of

applications for themyou can treatmore patients.”

One other notable area of therapeutic work at

Milan is the treatment of neuroendocrine tumours

withpeptide receptor radionuclide therapy–Paganelli

and colleagues have built onwork pioneered inRotterdamandBasel

on this technique. “These are rare

tumours, but not as rare as you think – and we can

show a benefit in more than 70% of patients, with

20%incomplete remission. It’s attractedcommercial

interest and we are looking at peptides for other

cancers.”He says thepeptide treatmenthas expanded

around Italy,with about 50 patients seen eachweek.

InMilan, quite a fewcome fromabroad for this and

other treatments such as for brain tumours.