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2015 ; 41
(6
): 503-10
Nephropedia Template TP
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English Wikipedia
The abscopal effect of local radiotherapy: using immunotherapy to make a rare
event clinically relevant
#MMPMID25872878
Reynders K
; Illidge T
; Siva S
; Chang JY
; De Ruysscher D
Cancer Treat Rev
2015[Jun]; 41
(6
): 503-10
PMID25872878
show ga
BACKGROUND: Recently, immunologic responses to localized irradiation are proposed
as mediator of systemic effects after localized radiotherapy (called the abscopal
effect). Here, we give an overview of both preclinical and clinical data about
the abscopal effect in particular and link them with the immunogenic properties
of radiotherapy. METHODS: We searched Medline and Embase with the search term
"abscopal", "(non-targeted irradiation) OR (non-targeted
radiotherapy)" and "distant bystander" from 1960 until July, 2014. Only papers
that cover radiotherapy in an oncological setting were selected and only if no
concurrent cytotoxic treatment was given. Targeted immune therapy was allowed.
RESULTS: Twenty-three case reports, one retrospective study and 13 preclinical
papers were selected. Eleven preclinical papers used a combination of immune
modification and radiotherapy to achieve abscopal effects. Patient age range
(28-83years) and radiation dose (median total dose 32Gy) varied. Fractionation
size ranged from 1.2Gy to 26Gy. Time to documented abscopal response ranged
between less than one and 24months, with a median reported time of 5months. Once
an abscopal response was achieved, a median time of 13months went by before
disease progression occurred or the reported follow-up ended (range 3-39months).
CONCLUSION: Preclinical data points heavily toward a strong synergy between
radiotherapy and immune treatments. Recent case reports already illustrate that
such a systemic effect of radiotherapy is possible when enhanced by targeted
immune treatments. However, several issues concerning dosage, timing, patient
selection and toxicity need to be resolved before the abscopal effect can become
clinically relevant.