Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-chou, Aoba-ku, Sendai, MIyagi, 980-8574, Japan.
Division of Radiology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, 1-15-1 Fukumuro, Miyagino-ku, Sendai, 983-8536, Japan.
J Med Case Rep. 2022 Mar 6;16(1):94. doi: 10.1186/s13256-022-03321-x.
The abscopal effect is a phenomenon in which a tumor located far from irradiated lesions regresses. We have experienced a case in which both intracranial and extracranial lesions showed an abscopal effect after radiotherapy for spinal metastases of unknown primary. We report the differential abscopal effect in extracranial and intracranial lesions.
A 57-year-old Japanese man was diagnosed with multiple lung nodules, bone metastases, and brain metastases. The results of pathological examination at the previous hospital he visited suggested adenocarcinoma of the lung. However, there was a possibility that the biopsy specimen was inadequate. Radiation therapy was performed on the ninth thoracic vertebra for a total dose of 39 Gy in 13 fractions because the lesion in the ninth thoracic vertebra was destructively extending. After thorough examination, the primary lesion could not be identified, and we made diagnosis of cancer of unknown primary. The patient did not want to receive systemic chemotherapy; however, all of the lesions except for the brain metastases had spontaneously shrunk 2 months after radiation therapy. Although the brain metastases had partially shrunk, whole-brain radiotherapy for a total dose of 36 Gy in 12 fractions was performed. Fifteen months after initial radiation therapy, the brain metastasis recurred, and Gamma Knife radiosurgery was additionally performed. The brain metastases disappeared after the radiosurgery. During a period of 30 months after radiation therapy for the ninth vertebra, the lesions of the trunk all maintained their shrinkage without systemic chemotherapy. Right cervical lymph node metastasis and brain metastases occurred 30 months after the initial radiation therapy. A biopsy of the right cervical lymph node led to the diagnosis of clear cell carcinoma. Although we considered additional radiation therapy or chemotherapy, the patient died 3 months after the progression of recurrence lesions.
We report a rare case in which radiotherapy alone for an extracranial metastatic lesion of a vertebra resulted in an abscopal effect on both extracranial and intracranial lesions. Notably, the abscopal effect in the intracranial lesions was weaker than that in the extracranial lesions.
远隔效应是一种远处照射病灶消退的现象。我们遇到过一例脊柱转移瘤的患者，在对其进行放疗后，颅内和颅外病灶均出现远隔效应。我们报告了颅外和颅内病灶的不同远隔效应。
一名 57 岁的日本男性被诊断为多发性肺结节、骨转移和脑转移。之前就诊的医院的病理检查结果提示为肺腺癌。但是，有可能活检标本不足。由于第九胸椎的病变呈破坏性延伸，对其进行了 39Gy 共 13 次的放疗。彻底检查后，仍未能确定原发灶，故诊断为不明原因的原发癌。患者不想接受全身化疗；然而，放疗后 2 个月，除脑转移外的所有病灶均自发缩小。尽管脑转移部分缩小，但仍对其进行了全脑放疗，总剂量 36Gy，共 12 次。初始放疗后 15 个月，脑转移复发，加行伽玛刀放射外科手术。放射外科手术后脑转移消失。在第九胸椎放疗后 30 个月的时间里，躯干的病灶均保持缩小，未进行全身化疗。初始放疗后 30 个月时出现右颈淋巴结转移和脑转移。对右颈淋巴结进行活检后诊断为透明细胞癌。虽然我们考虑了额外的放疗或化疗，但患者在复发转移病灶进展后 3 个月死亡。
我们报告了一例罕见的病例，即单独对椎体外转移灶进行放疗，导致颅外和颅内病灶均出现远隔效应。值得注意的是，颅内病灶的远隔效应弱于颅外病灶。
