单克隆抗体标载的^(131)Ⅰ脑胶质瘤瘤内放免治疗

Intratumoral Radioimmunotherapy for Brain Glioma by Radioiodinated Monoclonal Antibody

目的探讨131I-chTNT(131I-肿瘤细胞核人鼠嵌合单抗)通过局部化疗囊注入胶质瘤瘤腔内,行瘤内放免治疗的价值。方法选择全部经手术病理证实的脑胶质瘤56例,其中胶质母细胞瘤34例,星形细胞瘤22例。第1次手术者20例,余为复发性手术。术中瘤腔内置入化疗囊,手术后7d囊内注131I-chTNT1.1×103Bq,15d后重复注入1次。结果于末次注药后2个月复查CT或MRI,随访期6个月～2年2个月,完全缓解21例(37.5%),部分缓解24例(42.8%),临床症状减轻,病情稳定7例(12.5%),病情恶化4例(7.1%)。结论单克隆抗体与131I交联后靶向于肿瘤细胞核,与瘤体特异性结合,并将其荷载的放射性核素输送到肿瘤细胞内,由内向外摧毁肿瘤。临床疗效满意,优于其他类型的瘤内近距离放疗。

Objective To explore the clinical effectiveness of intratumoral radioimmunotherapy for brain glioma by radioiodinated monoclonal antibody （^131I-chTNT） via chemotherapy reservoir. Methods Fifty-six patients diagnosed as glioma （34 as glioblas- toma, 24 as astrocytoma） by pathology were enrolled. All the patients underwent surgical operation. Among them, 20 were performed operation for the first time, and the others were performed operation for recurrent tumors. The end of the chemotherapy reser- voir was placed in the resection cavity at the time of tumor deulking. Seven days later, ^131I-chTNT （ 1.1×103 Bq） was injected into the residual tumor via chemotherapy reservoir. The treatment was repeated in the following 15 - 20 days. Results All of the patients were reexamined with CT scanning or MRI after two months. The result of the follow-up showed that 21 cases （37.5%） reached complete remission, 24 （42.8%） reached partial remission, and 7 （ 12.5% ） reached clinical relief or stable condition. Only 4 cases （7.1%） were deteriorated. Conclusion The treatment with monoclonal antibody combined with ^131I- can target the nuclei of the tumor cells, and then the radioiodine transported into tumor cells destroys them. Intratumoral radiotherapy by ^131I- chTNT performs efficiently, and demonstrates a more significant virtue when compared with other interstitial brachytherapy for malignant brain tumors.