Karlsson B, Ericson K, Kihlström L, Grane P
Department of Neurosurgery, Karolinska Hospital, Stockholm, Sweden.
J Neurosurg. 1997 Aug;87(2):327-30. doi: 10.3171/jns.1997.87.2.0327.
In a series of 22 patients treated with gamma knife surgery for brain metastasis in whom biopsy specimens were obtained via stereotactically guided procedures before the radiosurgical treatment was administered, two cases with evidence of tumor seeding were observed on subsequent follow-up examination. These findings contradict the opinion that the risk for tumor spread after a biopsy is negligible. This evidence may be explained by the fact that radiosurgery leaves the surrounding tissue unaffected by the treatment, which results in preserved anatomy around the tumor. This allows the surgeon to define the previous biopsy channel and, consequently, whether a distant tumor recurrence may have resulted from tumor seeding related to the biopsy procedure. Additionally, radiosurgical treatment leaves tumor cells that may have been spread as a result of the biopsy unaffected, giving them the potential to divide and develop into a new tumor. In contrast to this, microsurgical removal of the tumor will affect the surrounding tissue, making it impossible to detect whether new metastases are resulting from seeding. Furthermore, conventional fractionated radiation therapy will sterilize tumor cells that may have spread, thus making it impossible for these cells to regrow. The authors conclude that the risk for tumor seeding following a stereotactically guided biopsy may be higher than previously assumed.
在一组22例接受伽玛刀手术治疗脑转移瘤的患者中，这些患者在进行放射外科治疗前通过立体定向引导程序获取了活检标本，在随后的随访检查中观察到2例有肿瘤播散的证据。这些发现与活检后肿瘤播散风险可忽略不计的观点相矛盾。这一证据可以用以下事实来解释：放射外科手术不会使周围组织受到治疗影响，从而使肿瘤周围的解剖结构得以保留。这使得外科医生能够确定先前的活检通道，进而确定远处肿瘤复发是否可能是由与活检程序相关的肿瘤播散所致。此外，放射外科治疗使可能因活检而播散的肿瘤细胞不受影响，使其有分裂并发展成新肿瘤的潜力。与此相反，肿瘤的显微手术切除会影响周围组织，从而无法检测新的转移瘤是否由播散引起。此外，传统的分次放射治疗会使可能已播散的肿瘤细胞失活，从而使这些细胞无法再生长。作者得出结论，立体定向引导活检后肿瘤播散的风险可能比之前设想的更高。
