title: Anatomical basis and histopathological changes resulting from selective internal radiotherapy for liver metastases.
abstract: BACKGROUND
  Knowledge that liver tumours preferentially take their blood supply from the arterial blood supply rather than the portal venous system can be used for local delivery of treatment or for embolisation to cut off the blood supply to tumours.
  
  
  OBJECTIVE
  To present histological evaluation of malignant and non-malignant hepatic tissue of one such therapy, selective internal radiation therapy (SIRT) with yttrium-90 microspheres, to decipher its principal mechanism of action.
  
  
  METHODS
  The H&E stained sections of hepatic resection specimens from three patients with liver metastases from colorectal (CRC) cancer, who underwent hepatic surgery 4-9 months following SIRT, were examined and the pathological changes documented.
  
  
  RESULTS
  Resin microspheres were identified in the vascular tumour bed and vessels within the portal tracts of the background liver parenchyma. Microspheres were usually associated with giant cell reaction or histiocytes. In the tumour bed, tumour necrosis, mucinous alteration, collections of foamy histiocytes, ectatic vessels, calcification and fibrosis were observed. There was minimal cellular inflammatory response observed, suggestive of direct radiation injury as a non-immune mediated process.
  
  
  CONCLUSIONS
  We describe in detail the spectrum of histopathological changes in malignant tissue and liver parenchyma in patients with metastatic CRC treated with SIRT. Our findings are consistent with the hypothesis that the principal mechanism of action of SIRT appears to be via arterially directed delivery of highly radioactive microspheres in and around the vascular tumour bed rather than by micro-arterial embolisation.
authors.affiliation: Department of Cellular Pathology, Oxford University Hospitals NHS Trust, John Radcliffe Hospital, Oxford, UK.
authors.forename: Lai Mun
authors.initials: LM
authors.lastname: Wang
authors.forename: Anant R
authors.initials: AR
authors.lastname: Jani
authors.forename: Esme J
authors.initials: EJ
authors.lastname: Hill
authors.forename: Ricky A
authors.initials: RA
authors.lastname: Sharma
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000556:secondary*; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001918:Brachytherapy; D015179:Colorectal Neoplasms / Q000473:pathology* / Q000532:radiotherapy; D003131:Combined Modality Therapy; D004621:Embolization, Therapeutic / Q000379:methods; D005260:Female; D006498:Hepatectomy; D006801:Humans; D007269:Injections, Intra-Arterial; D008113:Liver Neoplasms / Q000532:radiotherapy / Q000556:secondary*; D008863:Microspheres; D011859:Radiography; D016896:Treatment Outcome; D015021:Yttrium Radioisotopes / Q000627:therapeutic use*
chemical_list: D000970:Antineoplastic Agents; D015021:Yttrium Radioisotopes