■高剂量单叶放射栓塞,或“放射性肺叶切除术”(RL),是一种诱导疗法,可在同时照射肿瘤的同时实现对侧未来的肝残留肥大。因此,它可能会阻止进一步的增长,但尚不清楚RL是否会影响肝内淋巴管,肝脏肿瘤传播的主要途径。
这是乌得勒支大学医学中心进行的病例对照研究。该研究比较了接受RL(病例)的肝脏中的淋巴管与未接受RL(对照)的肝脏中的淋巴管。组织学样本是从2017年至2022年之间诊断为肝细胞癌(HCC)或结直肠肝转移(CRLM)的患者获得的。两名研究人员使用podoplanin分析了淋巴管形态,在淋巴内皮中表达的蛋白质。使用术中肝脏淋巴管造影(ILL)评估放射性栓塞肝脏的体内肝脏淋巴引流:在肝脏手术期间,将专利蓝染料注入肝实质,然后检查肝周淋巴结构的染色。将ILL结果与先前发表的队列进行比较。
■对来自10例CRLM患者和9例HCC患者的RL后肿瘤组织进行的免疫组织化学分析显示,与对照组相比,辐照的肝淋巴管形态异常(每组n=3)。辐射淋巴管弯曲(p<0.05),增厚(p<0.05)和不连续(p<0.05)。此外,RL后淋巴管有较大的流明(1.5-1.7倍,p<0.0001),表明淋巴淤滞。与未放射栓塞的对照组相比,ILL显示受照射的肝脏中肝周淋巴结和血管的淋巴引流减少(p=1.0x10-4)。
■放射性栓塞会损害肿瘤周围淋巴管功能。需要进一步的研究来评估放射性栓塞是否会通过该途径损害肿瘤的传播。
■Unilobar放射栓塞术可作为门静脉栓塞术的替代方案,用于因未来肝脏残存量不足而被认为不可切除的患者。这项研究表明,放射性栓塞损害肿瘤周围肝淋巴管的功能,有可能阻碍通过这种途径传播。这些发现为考虑单叶放射栓塞而不是标准门静脉栓塞提供了支持。
UNASSIGNED: High-dose unilobar radioembolization, or \'radiation lobectomy\' (RL), is an induction therapy that achieves contralateral future liver remnant hypertrophy while simultaneously irradiating the tumor. As such, it may prevent further growth, but it is unknown whether RL affects intrahepatic lymphatics, a major route via which liver tumors disseminate.
UNASSIGNED: This was a case-control study conducted at University Medical Center Utrecht. The study compared lymph vessels in livers that had undergone RL (cases) with those in livers that had not undergone RL (controls). Histological samples were acquired from patients diagnosed with hepatocellular carcinoma (HCC) or colorectal liver metastases (CRLM) between 2017 and 2022. Lymph vessel morphology was analyzed by two researchers using podoplanin, a protein that is expressed in lymphatic endothelium. In vivo liver lymph drainage of radioembolized livers was assessed using intraoperative liver lymphangiography (ILL): during liver surgery, patent blue dye was injected into the liver parenchyma, followed by inspection for staining of perihepatic lymph structures. ILL results were compared to a previously published cohort.
UNASSIGNED: Immunohistochemical analysis on post-RL tumor tissues from ten patients with CRLM and nine patients with HCC revealed aberrant morphology of irradiated liver lymphatics when compared to controls (n = 3 per group). Irradiated lymphatics were tortuous (p <0.05), thickened (p <0.05) and discontinuous (p <0.05). Moreover, post-RL lymphatics had larger lumens (1.5-1.7x, p <0.0001), indicating lymph stasis. ILL revealed diminished lymphatic drainage to perihepatic lymph nodes and vessels in irradiated livers when compared to non-radioembolized controls (p = 1.0x10-4).
UNASSIGNED: Radioembolization impairs peritumoral lymph vessel function. Further research is needed to evaluate if radioembolization impairs tumor dissemination via this route.
UNASSIGNED: Unilobar radioembolization can serve as an alternative to portal venous embolization for patients who are considered unresectable due to an insufficient future liver remnant. This research suggests that radioembolization impairs the function of peritumoral liver lymph vessels, potentially hindering dissemination via this route. These findings provide support for considering unilobar radioembolization over standard portal venous embolization.