1. Spine eburnation in a metastatic lung cancer patient treated with immunotherapy and radiotherapy. The first case report of bystander effect on bone.
- Author
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Parisi, Silvana, Napoli, Ilenia, Lillo, Sara, Cacciola, Alberto, Ferini, Gianluca, Iatì, Giuseppe, Pontoriero, Antonio, Tamburella, Consuelo, Davì, Valerio, and Pergolizzi, Stefano
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SPINE radiography , *LUNG cancer diagnosis , *RADIOBIOLOGY , *LUNG cancer , *ADENOCARCINOMA , *BRAIN , *IMMUNE checkpoint inhibitors , *BIOPSY , *SOLITARY pulmonary nodule , *RIB cage , *TIME , *VIRTUAL colonoscopy , *LUNG tumors , *METASTASIS , *RADIATION , *CELL physiology , *INDIVIDUALIZED medicine , *ANTINEOPLASTIC agents , *MAGNETIC resonance imaging , *CANCER patients , *TUMOR classification , *TREATMENT effectiveness , *BONE tumors , *GENE expression , *RADIATION doses , *COMBINED modality therapy , *RADIOTHERAPY , *RADIATION injuries , *MEMBRANE proteins , *RADIOSURGERY , *IMMUNOTHERAPY , *RADIOIMMUNOTHERAPY , *DISEASE management , *THORACIC vertebrae , *PHYSIOLOGICAL effects of radiation - Abstract
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. [ABSTRACT FROM AUTHOR]
- Published
- 2022
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