There is no central radiopharmacY

“There is no central radiopharmacy inEurope for
preparing monoclonal antibodies or peptides for
therapeutic purposes,” he says, adding that he is in
discussionwith colleagues to set up just such a facility
atEuropeanlevel, andalso at local level for the various
clinics in and aroundMilan.
The short half-life of many medical radioisotopes
doesmeanthat suppliesmust be constantly on
tap, andwhilemedical cyclotrons can produce some
isotopes, especially for glucose used in PET, others
such as the widely used technetium-99 and iodine-
131 aremainly produced in nuclear reactors (sometimes
as longer lived ‘parent’ isotopes that are then
used to generate ‘daughters’locally). In Italy, nuclear
reactors have been rejected by a referendum, so the
countrywill alwaysbedependent onoutside supplies.
That nuclearmedicine is dependent on a reliable
commercial supply of radioisotopes was brought
home very recently – a reactor in Canada that supplied
a large proportion of the worldwide market
was off-line longer thanexpectedlastDecember, leading
somemedical centres inNorthAmerica to postpone
procedures and to scramble around for
alternative supplies.
Paganelli’smostwell-knownwork, in breast cancer,
came in response to Veronesi’s drive to cut
unnecessary surgery. “In 1995 he askedme if I had
anything that could avoid axillary dissectionof lymph
nodes, perhaps using PET. I said we could look at
using blue dye to identify sentinel nodes,whichwas
also being done with melanoma. Looking further, I
realisedwe could optimise the approach, as blue dye
canmiss a lot of lymphnodes.”The resultwas the first
protocol for sentinel node lymphoscintigraphy in
breast cancer, identifying thenodeusing a radioactive
marker injected into the tumour to see the extent of
tumour spread. “I sent it to Veronesi, who was cautious,
but we started to optimise the amount of
radioactivity andsize ofparticlewewere injecting and
we published in 1997.