Platelet-Rich Fibrin in Total Laryngectomy: Long-Term Safety Concerns
We read with great interest the review titled Platelet-Rich Fibrin Enhances Surgical Wound Healing in Total Laryngectomy by Reksodiputro et al (Facial Plast Surg 2021. Doi: 10.1055/s-0040-1717083). This study aimed to investigate the effectiveness of platelet-rich fibrin (PRF) application in enhancing wound healing after total laryngectomy for laryngeal squamous cell carcinoma. But, is it safe to use PRF at a tumor bed?
To answer this question, we performed a thorough search of the literature. Several studies on cancer growth, progression, recurrence, and postoperative survival rate, focus on the tumor stroma, which represents a crucial parameter in tumor development. There is a complex interplay between endothelial, stromal, and tumor cells. Platelet-derived growth factors and receptors are pivotal in this interaction, and important targets in novel anticancer therapies.
The secretory proteins contained in the α-granules of platelets include platelet-derived growth factor (PDGF-AA, BB, and AB isomers), transforming growth factor-β (TGF-β), vascular endothelial growth factor (VEGF), epidermal growth factor (EGF), platelet-derived endothelial growth factor (PDEGF), and many others. The release of these growth factors stimulates angiogenesis, induces tumor lymphangiogenesis, and enhances nodal metastasis rate.
PRF has the potential for enhancing the healing process and consequently decreasing the incidence of pharyngocutaneous fistula, but it also has the potential for affecting patient's survival when applied on tumor excision sites. Therefore, we believe that the use of the platelet-rich concentrates is not indicated in patients undergoing resection for cancer.
The role of PRF in oncological operations deserves further experimental investigation and large-scale prospective randomized clinical trials. The use of novel reversibly switchable in vivo tumor models can elucidate the cause-and-effect chain of processes triggered by acute oncogene activation, providing an indication of the extent to which the tumor cell instructs its microenvironment versus the microenvironment instructing the tumor.
20. Juli 2021 (online)
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