Shields Lisa B E, Rezazadeh Kalebasty Arash
Norton Neuroscience Institute, Norton Healthcare, Louisville, Kentucky, USA.
Norton Cancer Institute, Norton Healthcare, Louisville, Kentucky, USA.
Case Rep Oncol. 2020 Oct 16;13(3):1285-1294. doi: 10.1159/000509509. eCollection 2020 Sep-Dec.
Renal cell carcinoma (RCC) is often metastatic at diagnosis. Conventional therapies such as chemotherapy, radiotherapy, and hormonal therapy have generally proven ineffective in the treatment of RCC. The abscopal effect, specifically, the ability of localized radiation to trigger systemic antitumor effects, has been reported to lead to regression of non-irradiated distant tumor lesions. Herein, we report 3 patients with non-metastatic clear cell RCC (CCRCC) who underwent a nephrectomy and experienced metachronous pulmonary/mediastinal metastases confirmed as CCRCC. No patients underwent radiation post-nephrectomy or pulmonary metastasectomy. The mean duration was 7.24 weeks from the last negative chest CT prior to the nephrectomy and 96.2 weeks post-nephrectomy. All patients achieved durable complete response by RECIST criteria, with a mean follow-up duration of 115 months. Our case series represents the largest in the literature of patients who underwent a nephrectomy for CCRCC with no pre-existing pulmonary/mediastinal metastatic disease confirmed by chest CT, did not undergo radiotherapy, and developed significantly delayed CCRCC pulmonary/mediastinal metastases. We highlight the spontaneous regression of delayed metastatic disease and the role of immune responses in curtailing the growth of pulmonary metastasis in CCRCC.
肾细胞癌（RCC）在诊断时通常已发生转移。化疗、放疗和激素治疗等传统疗法在RCC治疗中一般已被证明无效。特别是远隔效应，即局部放疗触发全身抗肿瘤效应的能力，据报道可导致未受照射的远处肿瘤病灶消退。在此，我们报告3例非转移性透明细胞肾细胞癌（CCRCC）患者，他们接受了肾切除术，并出现了经证实为CCRCC的异时性肺/纵隔转移。肾切除术后或肺转移瘤切除术后均未进行放疗。从肾切除术前最后一次胸部CT阴性到肾切除术后的平均时间为7.24周和96.2周。所有患者均按照RECIST标准实现了持久的完全缓解，平均随访时间为115个月。我们的病例系列是文献中最大的一组，这些患者接受了CCRCC肾切除术，术前胸部CT未证实存在肺/纵隔转移疾病，未接受放疗，且出现了显著延迟的CCRCC肺/纵隔转移。我们强调了延迟转移疾病的自发消退以及免疫反应在抑制CCRCC肺转移生长中的作用。
