Spine eburnation in a metastatic lung cancer patient treated with immunotherapy and radiotherapy. The first case report of bystander effect on bone
| Autor: | Giuseppe Iatì, Antonio Pontoriero, Alberto Cacciola, Stefano Pergolizzi, Valerio Davì, Ilenia Napoli, Silvana Parisi, Gianluca Ferini, Sara Lillo, Consuelo Tamburella |
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| Jazyk: | angličtina |
| Rok vydání: | 2022 |
| Předmět: |
0301 basic medicine
Oncology medicine.medical_specialty Lung Neoplasms medicine.medical_treatment bystander effect immunotherapy lung cancer Radiotherapy Targeted therapy 03 medical and health sciences Therapeutic approach 0302 clinical medicine Internal medicine Carcinoma Non-Small-Cell Lung Positron Emission Tomography Computed Tomography Bystander effect medicine Humans Pharmacology (medical) Lung cancer Aged business.industry Immunotherapy Bystander Effect medicine.disease Spine Radiation therapy 030104 developmental biology 030220 oncology & carcinogenesis Eburnation Metastatic lung cancer Female business |
| Popis: | Introduction Metastatic non-small cell lung cancer (NSCLC) is nowadays treated with a multimodal therapeutic approach including immunotherapy, targeted therapy and radiotherapy. Radiation therapy, in addition to immune checkpoint inhibitors, gives rise to a particular radiobiological effect known as “bystander effect” consisting of the radiation-induced damage in nearby unirradiated cells. Case report We report a case of a 79-year-old female patient with stage IV NSCLC treated with concomitant immuno-radiotherapy who showed a bystander effect on bone. Management and outcome: Primary tumour biopsy revealed an adenocarcinoma with a PDL1 expression >50%, while staging exams showed a right pulmonary lesion with a partial involvement of the contiguous rib and a single brain metastasis. The patient refused chemotherapy, so that Pembrolizumab 2 mg/Kg was administered every 3 weeks. After two administrations, the single brain metastasis was treated using stereotactic radiosurgery while the site of primitive lung cancer received an 8 Gy-single fraction 3 D-conformal radiotherapy. Three months after irradiation a chest CT showed a radiological remission of about 10% of the GTV and a partial eburnation of the vertebra located nearby the target volume. The CT images of a PET/CT at six months showed a complete vertebral eburnation. At the last follow-up, the patient was free of disease (brain MRI, spinal MRI and PET/CT). Discussion The present case alerts for unusual side effects provoked by bystander phenomenon in patients treated with a combination of immunotherapy and irradiation. Immune activation exacerbates the bystander effect causing normal tissues toxicities beyond what immunotherapies are causing by themselves. |
| Databáze: | OpenAIRE |
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