Yesmembetov Kakharman, Sahin Cennet, Murad Mohamad, Berres Marie-Luise, Koch Alexander, von Websky Martin, Vondran Florian, Bruners Philipp, Eble Michael, Mohamed Ahmed Allam
Gastroenterology, Hepatology and infectious Diseases Department, University Hospital RWTH Aachen, Aachen, Germany.
Center for Integrated Oncology Aachen, Bonn, Cologne and Duesseldorf (CIO ABCD), Aachen, Germany.
Strahlenther Onkol. 2025 Feb 4. doi: 10.1007/s00066-024-02361-0.
This report details the reactivation of immune checkpoint inhibitor (ICI)-related autoimmune hepatitis triggered by stereotactic body radiation therapy (SBRT) in a 55-year-old male with hilar cholangiocellular carcinoma. Initially diagnosed in December 2021, the patient underwent successful resection and subsequent adjuvant therapy. Despite stable disease following chemotherapy augmented with durvalumab, he developed grade 3 acute hepatitis after seven cycles of durvalumab. Following a brief prednisolone regimen and normalization of liver tests, SBRT targeting para-aortic lymph nodes was initiated. Remarkably, severe hepatitis reoccurred 7 days after starting SBRT, 88 days following the last durvalumab infusion, necessitating resumed and escalated prednisolone treatment. Another course of SBRT for a newly diagnosed metastatic liver lesion was administered in September 2023, with ongoing prednisolone adjustment. By February 2024, liver tests normalized, but subsequent radiological assessments indicated tumor progression, leading to the reintroduction of chemotherapy. This case underscores the potential of SBRT for activating severe immune-mediated hepatotoxicity in patients treated with ICIs, highlighting the need for careful monitoring and management of such patients. Further, this report highlights the possible survival benefit of the strategic application of SBRT in addition to systematic treatment in recurrent and metastatic cholangiocellular carcinoma.
本报告详细介绍了一名55岁肝门部胆管细胞癌男性患者，因立体定向体部放射治疗（SBRT）引发免疫检查点抑制剂（ICI）相关自身免疫性肝炎的再激活情况。该患者于2021年12月首次确诊，接受了成功的手术切除及后续辅助治疗。尽管在使用度伐利尤单抗强化化疗后病情稳定，但在接受七个周期的度伐利尤单抗治疗后，他出现了3级急性肝炎。在短期使用泼尼松龙治疗且肝功能检查恢复正常后，开始对腹主动脉旁淋巴结进行SBRT治疗。值得注意的是，在开始SBRT治疗7天后，即最后一次输注度伐利尤单抗88天后，严重肝炎再次出现，因此需要恢复并加大泼尼松龙治疗剂量。2023年9月，针对新诊断的肝转移病灶进行了另一疗程的SBRT治疗，同时持续调整泼尼松龙剂量。到2024年2月，肝功能检查恢复正常，但随后的影像学评估显示肿瘤进展，于是重新开始化疗。该病例强调了SBRT在接受ICI治疗的患者中激活严重免疫介导肝毒性的可能性，突出了对此类患者进行密切监测和管理的必要性。此外，本报告还强调了在复发性和转移性胆管细胞癌的系统治疗基础上，SBRT战略应用可能带来的生存获益。
