累及野放疗后经正电子发射断层扫描证实的淋巴瘤远隔消退。
Abscopal Regressions of Lymphoma After Involved-Site Radiation Therapy Confirmed by Positron Emission Tomography.
机构信息
Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia; The Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia.
The Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia; Department of Molecular Imaging, Peter MacCallum Cancer Centre, Melbourne, Australia.
出版信息
Int J Radiat Oncol Biol Phys. 2020 Sep 1;108(1):204-211. doi: 10.1016/j.ijrobp.2020.02.636. Epub 2020 Mar 7.
PURPOSE
Patients with abscopal regressions of lymphoma after palliative involved-site radiation therapy (ISRT), detected on sequential F-fluorodeoxyglucose positron emission tomography (FDG-PET), were identified by audit. A retrospective analysis was subsequently conducted to estimate the frequency of abscopal regression in follicular lymphoma (FL).
METHODS AND MATERIALS
Potential cases were identified at multidisciplinary lymphoma meetings and fulfilled these criteria: (1) palliative ISRT given for histologically confirmed lymphoma, (2) >2 lesions visualized on FDG-PET, (3) >1 unirradiated lesion(s) outside ISRT volume, (4) no systemic therapy delivered <2 months before radiation therapy or between radiation therapy and response assessment, (5) complete metabolic response (CMR) in ≥1 unirradiated lesions detected on serial FDG-PET/CT. All ISRT patients with FL treated in 2016 to 2018 were systematically reviewed.
RESULTS
Seven cases of abscopal regression were identified, including 4 patients with FL. In all cases, a CMR was apparent both within the ISRT volume and in ≥1 unirradiated lesions. One patient each was identified with mantle cell lymphoma (4 Gy in 2 fractions), Hodgkin lymphoma (20 Gy in 3 fractions, then 30 Gy in 15 fractions to the same volume), and Richter transformation of chronic lymphatic leukemia (30 Gy in 10 fractions). The 4 patients with FL received either 4 Gy in 2 fractions (n = 3) or 4 Gy followed 8 months later by 30 Gy in 15 fractions (n = 1). From 2016 to 2018, 29 courses of ISRT were prescribed for multifocal FL, after which 4 of 29 (13.8%) abscopal responses were detected, including in 4 of 9 (44.4%) patients with serial PET scans. Two patients, with relapsed disease after initial abscopal responses, experienced durable CMRs with immunotherapies.
CONCLUSIONS
In 4 of 7 cases, PET-detected abscopal regression of lymphoma occurred after 4 Gy, in 2 of 7 cases after repeated ISRT to the same volume, and in 2 of 7 was associated with subsequent complete response to immunotherapy, consistent with an immune basis for the abscopal effect. Abscopal regressions in FL appear to be more common than previously suspected.
目的
通过审核，确定了姑息性累及部位放射治疗（ISRT）后淋巴瘤患者的远处退缩反应，这些患者在连续氟-18 氟代脱氧葡萄糖正电子发射断层扫描（FDG-PET）上得到了检测。随后进行了回顾性分析，以估计滤泡性淋巴瘤（FL）中远处退缩反应的频率。
方法和材料
在多学科淋巴瘤会议上确定了潜在病例，并符合以下标准：（1）因组织学证实的淋巴瘤给予姑息性 ISRT；（2）FDG-PET 上可见>2 处病变；（3）ISRT 体积外有>1 处未照射的病变；（4）在放射治疗前<2 个月或在放射治疗和反应评估之间没有给予全身治疗；（5）在连续 FDG-PET/CT 上检测到的≥1 处未照射病变中完全代谢缓解（CMR）。对 2016 年至 2018 年治疗的所有 FL 累及部位放射治疗患者进行了系统性回顾。
结果
共发现 7 例远处退缩反应，其中 4 例为 FL。在所有病例中，ISRT 体积内和≥1 处未照射的病变均出现了 CMR。分别有 1 例为套细胞淋巴瘤（2 次分割，每次 4 Gy）、霍奇金淋巴瘤（3 次分割，每次 20 Gy，然后在同一部位给予 15 次分割，每次 30 Gy）和慢性淋巴细胞白血病的 Richter 转化（10 次分割，每次 30 Gy）。4 例 FL 患者分别接受 2 次分割 4 Gy（n=3）或 4 Gy 后 8 个月接受 15 次分割 30 Gy（n=1）。2016 年至 2018 年，共进行了 29 次 ISRT 治疗多灶性 FL，随后在 29 例患者中检测到 4 例（13.8%）远处退缩反应，其中 9 例患者（44.4%）进行了连续 PET 扫描。2 例初始远处退缩反应后复发的患者接受免疫治疗后，获得了持久的 CMR。
结论
在 7 例患者中，4 例（7 例中的 4 例）在接受 4 Gy 后，2 例（7 例中的 2 例）在对同一部位进行重复 ISRT 后，2 例（7 例中的 2 例）在随后对免疫治疗产生完全反应时，PET 检测到淋巴瘤的远处退缩反应，这与远处效应的免疫基础一致。FL 中的远处退缩反应似乎比以前怀疑的更常见。
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