Sakashita Tomohiro, Homma Akihiro, Oridate Nobuhiko, Suzuki Seigo, Hatakeyama Hiromitsu, Kano Satoshi, Mizumachi Takatsugu, Yoshida Daisuke, Fujima Noriyuki, Fukuda Satoshi
Department of Otolaryngology-Head & Neck Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
Acta Otolaryngol. 2012 Oct;132(10):1121-5. doi: 10.3109/00016489.2012.680494. Epub 2012 Jun 5.
We conclude that intra-arterially injected cisplatin passed via lymph flow into sentinel nodes (SNs) as the platinum concentration in the SNs was higher than that in the non-sentinel nodes (NSNs). It is possible that preoperative intra-arterial chemotherapy targeting primary cancer also has a therapeutic effect on subclinical metastatic SNs.
Intra-arterial chemoradiotherapy has been reported to be effective against not only primary tumors but also nodal metastases. We considered the hypothesis that intra-arterially injected cisplatin passed via lymph flow into regional nodes. This study aimed to investigate intra-arterially injected cisplatin distribution to regional nodes by comparing platinum concentrations in SNs and NSNs.
Five patients with T1-2 N0 tongue cancer were treated with preoperative intra-arterial chemotherapy (cisplatin, 100 mg/m(2)) targeting primary cancer. Partial glossectomy together with SN biopsy and elective neck dissection were performed 2 weeks after intra-arterial chemotherapy. Platinum concentrations in the lymph nodes were measured using a Zeeman atomic absorption spectrometer.
Thirteen SNs were harvested together with eight NSNs from the areas adjacent to the SNs. Platinum concentrations were then measured, revealing a significant difference in platinum concentration between the SNs and the NSNs (mean ± SD, 0.682 ± 0.246 µg/g vs 0.506 ± 0.274 µg/g; p = 0.049).
我们得出结论，经动脉内注射的顺铂通过淋巴流进入前哨淋巴结（SNs），因为前哨淋巴结中的铂浓度高于非前哨淋巴结（NSNs）中的铂浓度。术前针对原发性癌症的动脉内化疗对亚临床转移性前哨淋巴结也可能具有治疗作用。
据报道，动脉内放化疗不仅对原发性肿瘤有效，而且对淋巴结转移也有效。我们考虑了经动脉内注射的顺铂通过淋巴流进入区域淋巴结的假说。本研究旨在通过比较前哨淋巴结和非前哨淋巴结中的铂浓度，研究经动脉内注射的顺铂在区域淋巴结中的分布情况。
5例T1-2 N0期舌癌患者接受了针对原发性癌症的术前动脉内化疗（顺铂，100 mg/m²）。动脉内化疗2周后进行部分舌切除术，同时进行前哨淋巴结活检和选择性颈清扫术。使用塞曼原子吸收光谱仪测量淋巴结中的铂浓度。
从前哨淋巴结相邻区域共采集了13个前哨淋巴结和8个非前哨淋巴结。随后测量铂浓度，结果显示前哨淋巴结和非前哨淋巴结之间的铂浓度存在显著差异（平均值±标准差，0.682±0.246μg/g对0.506±0.274μg/g；p = 0.049）。
