Lee Youjin, Auh Sogyong L, Wang Yugang, Burnette Byron, Wang Yang, Meng Yuru, Beckett Michael, Sharma Rohit, Chin Robert, Tu Tony, Weichselbaum Ralph R, Fu Yang-Xin
Department of Pathology, University of Chicago, 5841 S Maryland Ave., Chicago, IL 60637, USA.
Blood. 2009 Jul 16;114(3):589-95. doi: 10.1182/blood-2009-02-206870. Epub 2009 Apr 6.
Patients with locally advanced cancer or distant metastasis frequently receive prolonged treatment with chemotherapy and/or fractionated radiotherapy (RT). Despite the initial clinical response, treatment resistance frequently develops and cure in these patients is uncommon. Developments in RT technology allow for the use of high-dose (or ablative) RT to target local tumors, with limited damage to the surrounding normal tissue. We report that reduction of tumor burden after ablative RT depends largely on T-cell responses. Ablative RT dramatically increases T-cell priming in draining lymphoid tissues, leading to reduction/eradication of the primary tumor or distant metastasis in a CD8(+) T cell-dependent fashion. We further demonstrate that ablative RT-initiated immune responses and tumor reduction are abrogated by conventional fractionated RT or adjuvant chemotherapy but greatly amplified by local immunotherapy. Our study challenges the rationale for current RT/chemotherapy strategies and highlights the importance of immune activation in preventing tumor relapse. Our findings emphasize the need for new strategies that not only reduce tumor burden but also enhance the role of antitumor immunity.
局部晚期癌症或远处转移的患者经常接受长时间的化疗和/或分割放疗(RT)。尽管有初始临床反应,但这些患者经常出现治疗抵抗,治愈情况并不常见。放疗技术的发展使得高剂量(或消融性)放疗可用于靶向局部肿瘤,对周围正常组织的损伤有限。我们报告消融性放疗后肿瘤负荷的降低很大程度上取决于T细胞反应。消融性放疗显著增加引流淋巴组织中的T细胞致敏,以CD8(+) T细胞依赖的方式导致原发性肿瘤缩小/根除或远处转移。我们进一步证明,传统分割放疗或辅助化疗可消除消融性放疗引发的免疫反应和肿瘤缩小,但局部免疫疗法可极大地增强这种反应。我们的研究对当前放疗/化疗策略的基本原理提出了挑战,并强调了免疫激活在预防肿瘤复发中的重要性。我们的发现强调了不仅要降低肿瘤负荷,还要增强抗肿瘤免疫作用的新策略的必要性。