Macki Mohamed, Fakih Mohamed, Elmenini Jaafar, Anand Sharath Kumar, Robin Adam M
Neurosurgery, Henry Ford Hospital, Detroit, USA.
Cureus. 2019 Oct 5;11(10):e5844. doi: 10.7759/cureus.5844.
While the abscopal effect has been previously described, the phenomenon has been poorly defined in the case of spinal metastases. This article is unique in that we present the first systematic review of the abscopal effect after radiation therapy to metastatic spinal cancer, especially since the spinal column represents one of the most common metastatic locations. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines in the Enhancing the QUAlity and Transparency Of health Research (EQUATOR) resources, a systematic review identified relevant studies via a computer-aided search of MEDLINE and Embase. Ten publications that met the inclusion and exclusion criteria from the PRISMA flow diagram described a total of 13 patients, 76.9% of whom demonstrated image findings of the abscopal effect. In summary, important trends in the nine patients who experienced the abscopal effect in this review include higher doses of radiation and treatment with immunomodulators, both of which may help guide treatment paradigms for spinal metastases superimposed on diffuse metastatic disease. These trends, however, still warrant further investigations with experimental and clinical studies for a mechanistic understanding of the abscopal effect.
虽然远隔效应此前已有描述，但在脊柱转移瘤的情况下，该现象的定义尚不明确。本文的独特之处在于，我们首次对转移性脊柱癌放疗后的远隔效应进行了系统综述，尤其是因为脊柱是最常见的转移部位之一。按照健康研究质量提升和透明度增强（EQUATOR）资源中系统综述和Meta分析的首选报告项目（PRISMA）指南，通过对MEDLINE和Embase进行计算机辅助检索，确定了相关研究。PRISMA流程图中符合纳入和排除标准的10篇出版物共描述了13例患者，其中76.9%表现出远隔效应的影像学表现。总之，在本综述中经历远隔效应的9例患者的重要趋势包括更高剂量的放疗和免疫调节剂治疗，这两者都可能有助于指导叠加在弥漫性转移性疾病上的脊柱转移瘤的治疗模式。然而，这些趋势仍需要通过实验和临床研究进行进一步调查，以从机制上理解远隔效应。
