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다국어 초록 (Multilingual Abstract)

The abscopal effect is a term that has been used to describe the phenomenon in which localized radiation therapy treatment of a tumor lesion triggers a spontaneous regression of metastatic lesion(s) at a non-irradiated distant site(s). Radiation therapy induced abscopal effects are believed to be mediated by activation and stimulation of the immune system. However, due to the brain’s distinctive immune microenvironment, extracranial abscopal responses following cranial radiation therapy have rarely been reported. In this report, we describe the case of 42-year-old female patient with metastatic melanoma who experienced an abscopal response following her cranial radiation therapy for her brain metastasis. The patient initially presented with a stage III melanoma of the right upper skin of her back. Approximately 5 years after her diagnosis, the patient developed a large metastatic lesion in her upper right pectoral region of her chest wall and axilla. Since the patient’s tumor was positive for BRAF and MEK, targeted therapy with dabrafenib and trametinib was initiated. However, the patient experienced central nervous system (CNS) symptoms such as headache and disequilibrium and developed brain metastases prior to the start of targeted therapy. The patient received radiation therapy to a dose of 30 Gy delivered in 15 fractions to her brain lesions while the patient was on dabrafenib and trametinib therapy.
The patient’s CNS metastases improved significantly within weeks of her therapy. The patient’s non-irradiated large extracranial chest mass and axilla mass also shrank substantially demonstrating the abscopal effect during her CNS radiation therapy. Following radiation therapy of her residual chest lesions, the patient was disease free clinically and her CNS lesions had regressed. However, when the radiation therapy ended and the patient continued her targeted therapy alone, recurrence outside of her previously treated fields was noted. The disease recurrence could be due to the possibility of developing BRAF resistance clones to the BRAF targeted therapy. The patient died eventually due to wide spread systemic disease recurrence despite targeted therapy

참고문헌 (Reference)

1 Mole RH, "Whole body irradiation; radiobiology or medicine?" 26 : 234-241, 1953

2 Ngwa W, "Using immunotherapy to boost the abscopal effect" 18 : 313-322, 2018

3 Moriceau G, "Tunable-combinatorial mechanisms of acquired resistance limit the efficacy of BRAF/MEK cotargeting but result in melanoma drug addiction" 27 : 240-256, 2015

4 Park B, "The effect of radiation on the immune response to cancers" 15 : 927-943, 2014

5 Abuodeh Y, "Systematic review of case reports on the abscopal effect" 40 : 25-37, 2016

6 Ishiyama H, "Spontaneous regression of thoracic metastases while progression of brain metastases after stereotactic radiosurgery and stereotactic body radiotherapy for metastatic renal cell carcinoma: abscopal effect prevented by the blood-brain barrier?" 10 : 196-198, 2012

7 Okwan-Duodu D, "Role of radiation therapy as immune activator in the era of modern immunotherapy for metastatic malignant melanoma" 38 : 119-125, 2015

8 Eric C. Ko, "Radiotherapy and checkpoint inhibitors: a winning new combination?" SAGE Publications 10 : 175883591876824-, 2018

9 Negi N, "Not an immunoprivilaged site anymore but a virtual secondary lymphoid organ" 37 : 57-68, 2018

10 Weber JS, "Nivolumab versus chemotherapy in patients with advanced melanoma who progressed after anti-CTLA-4 treatment (CheckMate 037): a randomised, controlled, open-label, phase 3 trial" 16 : 375-384, 2015