Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Queen Elizabeth ii Health Sciences Centre and Dalhousie University, Halifax, NS.
Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, U.S.A.
Curr Oncol. 2020 Dec;27(6):330-335. doi: 10.3747/co.27.6687. Epub 2020 Dec 1.
The abscopal effect is a rarely observed outcome of radiotherapy wherein there is a reduction in metastatic disease burden outside of the targeted treatment area. Likely due to an vaccine effect of radiotherapy, the abscopal effect may be augmented by immunotherapy. This report is the first case of the abscopal effect observed in metastatic head-and-neck squamous cell carcinoma (hnscc) treated with concurrent radiotherapy and single-agent nivolumab.
An otherwise healthy 57-year-old man underwent craniofacial resection and adjuvant chemoradiotherapy for advanced sinonasal squamous cell carcinoma. Distant metastatic disease developed shortly after primary treatment, and immunotherapy in the form of nivolumab was initiated. Subsequent oligometastatic progression despite immunotherapy prompted palliative radiotherapy to a single metastasis due to pending symptomatology. Post-radiotherapy, the abscopal effect was observed with all distant sites of metastatic disease shrinking. Five months following treatment, a sustained reduction in disease burden has been demonstrated.
We present the first case of the abscopal effect in a patient with metastatic hnscc treated with palliative radiotherapy concurrent with single-agent nivolumab immunotherapy, and only the third case of the abscopal effect in metastatic head-and-neck cancer. Dual treatment with immunotherapy and radiotherapy may be an important treatment option in the future, mediated through the abscopal effect.
远隔效应是放疗中一种罕见的观察结果，即靶区外转移性疾病负担减少。由于放疗的疫苗效应，远隔效应可能会被免疫疗法增强。这是首例接受同步放疗和单药纳武利尤单抗治疗的转移性头颈部鳞状细胞癌（hnscc）观察到的远隔效应病例。
一名 57 岁健康男性因鼻窦鳞状细胞癌行颅面切除术和辅助放化疗。原发治疗后不久即出现远处转移性疾病，采用纳武利尤单抗形式的免疫疗法。尽管进行了免疫治疗，但随后仍出现寡转移进展，并因即将出现症状而对单一转移灶进行姑息性放疗。放疗后，观察到所有远处转移部位的远隔效应均缩小。治疗后 5 个月，疾病负担持续减少。
我们报告了首例接受姑息性放疗和单药纳武利尤单抗免疫治疗的转移性 hnscc 患者的远隔效应，也是转移性头颈部癌中第三例远隔效应。免疫治疗和放疗的双重治疗可能是未来的一个重要治疗选择，通过远隔效应介导。
