medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2020-20-188-193medsovet-5955Research ArticleКЛИНИЧЕСКОЕ НАБЛЮДЕНИЕCLINICAL OBSERVATIONАбскопальный эффект у пациента с метастатическим немелкоклеточным раком легкого, возникший после курса лучевой терапии на головной мозгAbscopal effect in a patient with metastatic NSCLC following a course of radiation therapy to the brainhttps://orcid.org/0000-0002-3710-137XДенисоваЕ. С.DenisovaE. S.

Elena S. Denisova, Graduate Student of the Drug Therapy Department (Chemotherapeutic No. 17)

24, Kashirskoye Shosse, Moscow, 115478, Russia

denielena95@yandex.ruhttps://orcid.org/0000-0003-4469-502XЛактионовК. К.LaktionovK. K.

Лактионов Константин Константинович, доктор медицинских наук, профессор кафедры онкологии и лучевой терапии лечебного факультета, Российский национальный исследовательский медицинский университет имени Н.И. Пирогова; заведующий онкологическим отделением лекарственных методов лечения (химиотерапевтическое) №17, Национальный медицинский исследовательский центр онкологии имени Н.Н. Блохина

117997, Россия, Москва, ул. Островитянова, д. 1; 115478, Россия, Москва, Каширское шоссе, д. 24

Konstantin K. Laktionov, Dr. of Sci. (Med.), Professor of the Department of Oncology and Radiation Therapy of the Faculty of Medicine, Pirogov Russian National Research Medical University; Head of the Oncological Department of Medical Treatment Methods (Chemotherapeutic) №17, Blokhin National Medical Research Center of Oncology

1, Ostrovityanov St., Moscow, 117997, Russia; 24, Kashirskoye Shosse, Moscow, 115478, Russia

lkoskos@mail.ruhttps://orcid.org/0000-0002-5570-684XБорисоваТ. Н.BorisovaT. N.

Борисова Татьяна Николаевна, кандидат медицинских наук, старший научный сотрудник радиологического отделения Научно-исследовательского института клинической и экспериментальной радиологии

115478, Россия, Москва, Каширское шоссе, д. 24

Tatiana N. Borisova, Cand. of Sci. (Med.), Senior Researcher, Department of Radiological Research Institute of Clinical and Experimental Radiology

24, Kashirskoye Shosse, Moscow, 115478, Russia

tborisova111@gmail.comhttps://orcid.org/0000-0002-8967-7987АрдзинбаМ. С.ArdzinbaMerab. S.

Ардзинба Мераб Сергеевич, кандидат медицинских наук, научный сотрудник отделения лекарственных методов лечения (химиотерапевтическое) №17

115478, Россия, Москва, Каширское шоссе, д. 24

Merab S. Ardzinba, Cand. of Sci. (Med.), Oncologist, Oncological Department of Medicinal Methods of Treatment No. 17 (Chemotherapeutic)

24, Kashirskoye Shosse, Moscow, 115478, Russia

merabii@mail.ruhttps://orcid.org/0000-0002-0589-4299ФедороваА. А.FedorovaA. A.

Федорова Анна Андреевна, врач-онколог радиологического отделения Научно-исследовательского института клинической и экспериментальной радиологии

115478, Россия, Москва, Каширское шоссе, д. 24

Anna A. Fedorova, Oncologist of the Radiological Department of the Research Institute of Clinical and Experimental Radiology

24, Kashirskoye Shosse, Moscow, 115478, Russia

x-ray.lady@yandex.ruhttps://orcid.org/0000-0002-0620-2696ЮдинД. И.YudinD. I.

Юдин Денис Иванович, кандидат медицинских наук, старший научный сотрудник

115478, Россия, Москва, Каширское шоссе, д. 24

Denis I. Yudin, Cand. of Sci. (Med.), Senior Researcher

24, Kashirskoye Shosse, Moscow, 115478, Russia

yudinden@mail.ruhttps://orcid.org/0000-0002-2014-586XМагамедоваС. С.MagamedovaS. S.

Магамедова Султанат Сиражутдиновна, врач-рентгенолог рентгенодиагностического отделения Научно-исследовательского института клинической и экспериментальной радиологии

115478, Россия, Москва, Каширское шоссе, д. 24

Sultanat S. Magamedova, Radiologist of the X-ray diagnostic department of the Scientific Research Institute of Clinical and Experimental Radiology

24, Kashirskoye Shosse, Moscow, 115478, Russia

sultanat0111@mail.ruhttps://orcid.org/0000-0002-8371-3617АрдзинбаМ. С.ArdzinbaMilada A.

Ардзинба Милада Сергеевна, студент 4-го курса лечебного факультета

119991, Россия, Москва, ул. Трубецкая, д. 8, стр. 2

Milada S. Ardzinba, fourth year Student of the Medical Faculty

8, Bldg. 2, Trubetskaya St., Moscow, 119991, Russia

ardzinba.milada@mail.ruНациональный медицинский исследовательский центр онкологии им. Н.Н. БлохинаРоссияBlokhin National Medical Research Center of OncologyRussian FederationНациональный медицинский исследовательский центр онкологии им. Н.Н. Блохина; Российский национальный исследовательский медицинский университет им. Н.И. ПироговаРоссияBlokhin National Medical Research Center of OncologyRussian FederationПервый Московский государственный медицинский университет имени И.М. Сеченова (Сеченовский Университет)РоссияSechenov First Moscow State Medical University (Sechenov University)Russian Federation202021122020020188193Copyright © Денисова Е.С., Лактионов К.К., Борисова Т.Н., Ардзинба М.С., Федорова А.А., Юдин Д.И., Магамедова С.С., Ардзинба М.С., 20202020Денисова Е.С., Лактионов К.К., Борисова Т.Н., Ардзинба М.С., Федорова А.А., Юдин Д.И., Магамедова С.С., Ардзинба М.С.Denisova E.S., Laktionov K.K., Borisova T.N., Ardzinba M.S., Fedorova A.A., Yudin D.I., Magamedova S.S., Ardzinba M.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/5955

Абскопальный эффект был описан более 50 лет назад и представляет собой явление, при котором лучевая терапия способствует регрессии метастатических очагов, удаленных от места облучения. В течение десятилетий данный эффект характеризовался как редкий, необъяснимый феномен у пациентов, получавших лучевую терапию. На сегодняшний день абскопальный эффект все еще остается исключительным явлением: механизм, лежащий в его основе, до сих пор до конца не изучен. Считается, что он, вероятнее всего, связан с системными иммунными реакциями, возникающими под воздействием лучевой терапии.

Мы приводим случай 63-летнего пациента с распространенным периферическим раком верхней доли левого легкого, прогрессированием заболевания в виде метастатического поражения головного мозга и регрессией опухолевых очагов в легких после проведенной лучевой терапии на головной мозг, при этом пациент не получал дополнительного лечения в виде иммунотерапии. В статье рассматривается история абскопального эффекта, делается попытка понять механизмы его возникновения, что может помочь в дальнейшем улучшении результатов лечения больных с НМРЛ с помощью лучевой терапии и современных подходов к комплексному лечению рака.

The abscopal effect was described more than 50 years ago and is a phenomenon in which radiation therapy promotes the regression of metastatic foci remote from the site of radiation. For decades, this effect has been described as a rare, unexplained phenomenon in patients receiving radiation therapy. Today, the abscopal effect is still an exceptional phenomenon: the mechanism underlying it is still not fully understood. It is believed that the abscopal effect is most likely associated with systemic immune responses that occur under the influence of radiation therapy.

We present the case of a 63-year-old patient with advanced peripheral cancer of the upper lobe of the left lung, disease progression in the form of metastatic brain lesions and regression of tumor foci in the lungs after radiation therapy to the brain, while the patient did not receive additional treatment in the form of immunotherapy.

The article examines the history of the abscopal effect, an attempt is made to understand the mechanisms of its occurrence, which can help to further improve the results of treatment of patients with NSCLC using radiation therapy and modern approaches to complex cancer treatment.

немелкоклеточный рак легкоголучевая терапияаденокарциномаабскопальный эффектметастатическое поражениеголовной мозгклинический случайnon small cell lung cancerradiation therapyadenocarcinomaabscopal effectbrain metastasiscase reportReferencesOrth M., Lauber K., Niyazi M., Friedl A., Li M., Maihöfer C. et al. Current concepts in clinical radiation oncology. Radiat Environ Biophys. 2014;53(1):1–29. doi: 10.1007/s00411-013-0497-2.Orth M., Lauber K., Niyazi M., Friedl A., Li M., Maihöfer C. et al. Current concepts in clinical radiation oncology. Radiat Environ Biophys. 2014;53(1):1–29. doi: 10.1007/s00411-013-0497-2.Mole R.H. Whole body irradiation; radiobiology or medicine? Br J Radiol. 1953;26(305):234–241. doi: 10.1259/0007-1285-26-305-234.Mole R.H. Whole body irradiation; radiobiology or medicine? Br J Radiol. 1953;26(305):234–241. doi: 10.1259/0007-1285-26-305-234.Sklar G.N., Eddy H.A., Jacobs S.C., Kyprianou N. Combined antitumor effect of suramin plus irradiation in human prostate cancer cells: the role of apoptosis. J Urol. 1993;150(5 Pt 1):1526–1532. doi: 10.1016/s0022-5347(17)35835-4.Sklar G.N., Eddy H.A., Jacobs S.C., Kyprianou N. Combined antitumor effect of suramin plus irradiation in human prostate cancer cells: the role of apoptosis. J Urol. 1993;150(5 Pt 1):1526–1532. doi: 10.1016/s0022-5347(17)35835-4.Schaue D., McBride W.H. Opportunities and challenges of radiotherapy for treating cancer. Nat Rev Clin Oncol. 2015;12(9):527–540. doi: 10.1038/nrclinonc.2015.120.Schaue D., McBride W.H. Opportunities and challenges of radiotherapy for treating cancer. Nat Rev Clin Oncol. 2015;12(9):527–540. doi: 10.1038/nrclinonc.2015.120.Reynders K., Illidge T., Siva S., Chang J.Y., De Ruysscher D. The abscopal effect of local radiotherapy: using immunotherapy to make a rare event clinically relevant. Cancer Treat Rev. 2015;41(6):503–510. doi: 10.1016/j.ctrv.2015.03.011.Reynders K., Illidge T., Siva S., Chang J.Y., De Ruysscher D. The abscopal effect of local radiotherapy: using immunotherapy to make a rare event clinically relevant. Cancer Treat Rev. 2015;41(6):503–510. doi: 10.1016/j.ctrv.2015.03.011.Demaria S., Ng B., Devitt M.L., Babb J.S., Kawashima N., Liebes L., Formenti S.C. Ionizing radiation inhibition of distant untreated tumors (abscopal effect) is immune mediated. Int J Radiat Oncol Biol Phys. 2004;58(3):862– 870. doi: 10.1016/j.ijrobp.2003.09.012.Demaria S., Ng B., Devitt M.L., Babb J.S., Kawashima N., Liebes L., Formenti S.C. Ionizing radiation inhibition of distant untreated tumors (abscopal effect) is immune mediated. Int J Radiat Oncol Biol Phys. 2004;58(3):862– 870. doi: 10.1016/j.ijrobp.2003.09.012.Trowell O.A. The sensitivity of lymphocytes to ionising radiation. J Pathol Bacteriol. 1952;64(4):687–704. doi: 10.1002/path.1700640403.Trowell O.A. The sensitivity of lymphocytes to ionising radiation. J Pathol Bacteriol. 1952;64(4):687–704. doi: 10.1002/path.1700640403.Hoppe R.T., Fuks Z.Y., Strober S., Kaplan H.S. The long term effects of radiation of T and B lymphocytes in the peripheral blood after regional irradiation. Cancer. 1977;40(5):2071–2078. doi: 10.1002/1097-0142(197711)40:5<2071::aid-cncr2820400513>3.0.co;2-v.Hoppe R.T., Fuks Z.Y., Strober S., Kaplan H.S. The long term effects of radiation of T and B lymphocytes in the peripheral blood after regional irradiation. Cancer. 1977;40(5):2071–2078. doi: 10.1002/1097-0142(197711)40:5<2071::aid-cncr2820400513>3.0.co;2-v.Cao M.D., Chen Z.D., Xing Y. Gamma irradiation of human dendritic cells influences proliferation and cytokine profile of T cells in autologous mixed lymphocyte reaction. Cell Biol Int. 2004;28(3):223–228. doi: 10.1016/j.cellbi.2003.12.006.Cao M.D., Chen Z.D., Xing Y. Gamma irradiation of human dendritic cells influences proliferation and cytokine profile of T cells in autologous mixed lymphocyte reaction. Cell Biol Int. 2004;28(3):223–228. doi: 10.1016/j.cellbi.2003.12.006.Li N., Karin M. Ionizing radiation and short wavelength UV activate NF-kappaB through two distinct mechanisms. Proc Natl Acad Sci USA. 1998;95(22):13012–13017. doi: 10.1073/pnas.95.22.13012.Li N., Karin M. Ionizing radiation and short wavelength UV activate NF-kappaB through two distinct mechanisms. Proc Natl Acad Sci USA. 1998;95(22):13012–13017. doi: 10.1073/pnas.95.22.13012.Weichselbaum R.R., Liang H., Deng L., Fu Y.X. Radiotherapy and immunotherapy: a beneficial liaison? Nat Rev Clin Oncol. 2017;14(6):365–379. doi: 10.1038/nrclinonc.2016.211.Weichselbaum R.R., Liang H., Deng L., Fu Y.X. Radiotherapy and immunotherapy: a beneficial liaison? Nat Rev Clin Oncol. 2017;14(6):365–379. doi: 10.1038/nrclinonc.2016.211.Demaria S., Formenti S.C. Role of T lymphocytes in tumor response to radiotherapy. Front Oncol. 2012;2:95. doi: 10.3389/fonc.2012.00095.Demaria S., Formenti S.C. Role of T lymphocytes in tumor response to radiotherapy. Front Oncol. 2012;2:95. doi: 10.3389/fonc.2012.00095.Younes E., Haas G.P., Dezso B., Ali E., Maughan R.L., Kukuruga M.A. et al. Local tumor irradiation augments the response to IL-2 therapy in a murine renal adenocarcinoma. Cell Immunol. 1995;165(2):243–251. doi: 10.1006/cimm.1995.1211.Younes E., Haas G.P., Dezso B., Ali E., Maughan R.L., Kukuruga M.A. et al. Local tumor irradiation augments the response to IL-2 therapy in a murine renal adenocarcinoma. Cell Immunol. 1995;165(2):243–251. doi: 10.1006/cimm.1995.1211.Filatenkov A., Baker J., Mueller A., Kenkel J., Ahn G., Dutt S. et al. Ablative Tumor Radiation Can Change the Tumor Immune Cell Microenvironment to Induce Durable Complete Remissions. Clin Cancer Res. 2015;21(16):3727–3739. doi:10.1158/1078-0432.CCR-14-2824.Filatenkov A., Baker J., Mueller A., Kenkel J., Ahn G., Dutt S. et al. Ablative Tumor Radiation Can Change the Tumor Immune Cell Microenvironment to Induce Durable Complete Remissions. Clin Cancer Res. 2015;21(16):3727–3739. doi:10.1158/1078-0432.CCR-14-2824.Zeng J., See A., Phallen J., Jackson C., Belcaid Z., Ruzevick J. et al. Anti-PD-1 blockade and stereotactic radiation produce long-term survival in mice with intracranial gliomas. Int J Radiat Oncol Biol Phys. 2013;86(2):343–349. doi: 10.1016/j.ijrobp.2012.12.025.Zeng J., See A., Phallen J., Jackson C., Belcaid Z., Ruzevick J. et al. Anti-PD-1 blockade and stereotactic radiation produce long-term survival in mice with intracranial gliomas. Int J Radiat Oncol Biol Phys. 2013;86(2):343–349. doi: 10.1016/j.ijrobp.2012.12.025.Vanpouille-Box C., Diamond J.M., Pilones K.A., Zavadil J., Babb J.S., Formenti S.C. et al. TGFβ Is a Master Regulator of Radiation Therapy-Induced Antitumor Immunity. Cancer Res. 2015;75(11):2232–2242. doi: 10.1158/0008-5472.CAN-14-3511.Vanpouille-Box C., Diamond J.M., Pilones K.A., Zavadil J., Babb J.S., Formenti S.C. et al. TGFβ Is a Master Regulator of Radiation Therapy-Induced Antitumor Immunity. Cancer Res. 2015;75(11):2232–2242. doi: 10.1158/0008-5472.CAN-14-3511.Rodriguez-Ruiz M.E., Rodriguez I., Garasa S., Barbes B., Solorzano J.L., Perez-Gracia J.L. et al. Abscopal Effects of Radiotherapy Are Enhanced by Combined Immunostimulatory mAbs and Are Dependent on CD8 T Cells and Crosspriming. Cancer Res. 2016;76(20):5994–6005. doi: 10.1158/0008-5472.CAN-16-0549.Rodriguez-Ruiz M.E., Rodriguez I., Garasa S., Barbes B., Solorzano J.L., Perez-Gracia J.L. et al. Abscopal Effects of Radiotherapy Are Enhanced by Combined Immunostimulatory mAbs and Are Dependent on CD8 T Cells and Crosspriming. Cancer Res. 2016;76(20):5994–6005. doi: 10.1158/0008-5472.CAN-16-0549.Shiraishi K., Ishiwata Y., Nakagawa K., Yokochi S., Taruki C., Akuta T. et al. Enhancement of antitumor radiation efficacy and consistent induction of the abscopal effect in mice by ECI301, an active variant of macrophage inflammatory protein-1alpha. Clin Cancer Res. 2008;14(4):1159–1166. doi: 10.1158/1078-0432.CCR-07-4485.Shiraishi K., Ishiwata Y., Nakagawa K., Yokochi S., Taruki C., Akuta T. et al. Enhancement of antitumor radiation efficacy and consistent induction of the abscopal effect in mice by ECI301, an active variant of macrophage inflammatory protein-1alpha. Clin Cancer Res. 2008;14(4):1159–1166. doi: 10.1158/1078-0432.CCR-07-4485.Park S.S., Dong H., Liu X., Harrington S.M., Krco C.J., Grams M.P. et al. PD-1 Restrains Radiotherapy-Induced Abscopal Effect. Cancer Immunol Res. 2015;3(6):610–619. doi: 10.1158/2326-6066.CIR-14-0138.Park S.S., Dong H., Liu X., Harrington S.M., Krco C.J., Grams M.P. et al. PD-1 Restrains Radiotherapy-Induced Abscopal Effect. Cancer Immunol Res. 2015;3(6):610–619. doi: 10.1158/2326-6066.CIR-14-0138.Lee Y., Auh S., Wang Y., Burnette B., Wang Y., Meng Y. et al. Therapeutic effects of ablative radiation on local tumor require CD8+ T cells: changing strategies for cancer treatment. Blood. 2009;114(3):589–595. doi: 10.1182/blood-2009-02-206870.Lee Y., Auh S., Wang Y., Burnette B., Wang Y., Meng Y. et al. Therapeutic effects of ablative radiation on local tumor require CD8+ T cells: changing strategies for cancer treatment. Blood. 2009;114(3):589–595. doi: 10.1182/blood-2009-02-206870.Yoshimoto Y., Suzuki Y., Mimura K., Ando K., Oike T., Sato H. et al. Radiotherapy-induced anti-tumor immunity contributes to the therapeutic efficacy of irradiation and can be augmented by CTLA-4 blockade in a mouse model. PLoS One. 2014;9(3):e92572. doi: 10.1371/journal.pone.0092572.Yoshimoto Y., Suzuki Y., Mimura K., Ando K., Oike T., Sato H. et al. Radiotherapy-induced anti-tumor immunity contributes to the therapeutic efficacy of irradiation and can be augmented by CTLA-4 blockade in a mouse model. PLoS One. 2014;9(3):e92572. doi: 10.1371/journal.pone.0092572.Tang C., Welsh J.W., de Groot P., Massarelli E., Chang J.Y., Hess K.R. et al. Ipilimumab with Stereotactic Ablative Radiation Therapy: Phase I Results and Immunologic Correlates from Peripheral T Cells. Clin Cancer Res. 2017;23(6):1388–1396. doi: 10.1158/1078-0432.CCR-16- 1432.Tang C., Welsh J.W., de Groot P., Massarelli E., Chang J.Y., Hess K.R. et al. Ipilimumab with Stereotactic Ablative Radiation Therapy: Phase I Results and Immunologic Correlates from Peripheral T Cells. Clin Cancer Res. 2017;23(6):1388–1396. doi: 10.1158/1078-0432.CCR-16- 1432.Wang R., Zhou T., Liu W., Zuo L. Molecular mechanism of bystander effects and related abscopal/cohort effects in cancer therapy. Oncotarget. 2018;9(26):18637–18647. doi: 10.18632/oncotarget.24746.Wang R., Zhou T., Liu W., Zuo L. Molecular mechanism of bystander effects and related abscopal/cohort effects in cancer therapy. Oncotarget. 2018;9(26):18637–18647. doi: 10.18632/oncotarget.24746.Hamid O., Robert C., Daud A., Hodi S., Hwu W.J., Kefford R. et al. Safety and tumor responses with lambrolizumab (anti-PD-1) in melanoma. N Engl J Med. 2013;369(2):134–144. doi: 10.1056/NEJMoa1305133.Hamid O., Robert C., Daud A., Hodi S., Hwu W.J., Kefford R. et al. Safety and tumor responses with lambrolizumab (anti-PD-1) in melanoma. N Engl J Med. 2013;369(2):134–144. doi: 10.1056/NEJMoa1305133.Gaipl U.S., Multhoff G., Scheithauer H., Lauber K., Hehlgans S., Frey B., Rödel F. Kill and spread the word: stimulation of antitumor immune responses in the context of radiotherapy. Immunotherapy. 2014;6(5):597–610. doi: 10.2217/imt.14.38.Gaipl U.S., Multhoff G., Scheithauer H., Lauber K., Hehlgans S., Frey B., Rödel F. Kill and spread the word: stimulation of antitumor immune responses in the context of radiotherapy. Immunotherapy. 2014;6(5):597–610. doi: 10.2217/imt.14.38.Habets T.H., Oth T., Houben A.W., Huijskens M.J., Senden-Gijsbers B.L., Schnijderberg M.C. et al. Fractionated Radiotherapy with 3 x 8 Gy Induces Systemic Anti-Tumour Responses and Abscopal Tumour Inhibition without Modulating the Humoral Anti-Tumour Response. PLoS One. 2016;11(7):e0159515. doi: 10.1371/journal.pone.0159515.Habets T.H., Oth T., Houben A.W., Huijskens M.J., Senden-Gijsbers B.L., Schnijderberg M.C. et al. Fractionated Radiotherapy with 3 x 8 Gy Induces Systemic Anti-Tumour Responses and Abscopal Tumour Inhibition without Modulating the Humoral Anti-Tumour Response. PLoS One. 2016;11(7):e0159515. doi: 10.1371/journal.pone.0159515.Camphausen K., Moses M.A., Ménard C., Sproull M., Beecken W.D., Folkman J., O’Reilly M.S. Radiation abscopal antitumor effect is mediated through p53. Cancer Res. 2003;63(8):1990–1993. Available at: https://pubmed.ncbi.nlm.nih.gov/12702593.Camphausen K., Moses M.A., Ménard C., Sproull M., Beecken W.D., Folkman J., O’Reilly M.S. Radiation abscopal antitumor effect is mediated through p53. Cancer Res. 2003;63(8):1990–1993. Available at: https://pubmed.ncbi.nlm.nih.gov/12702593.de Araújo Farias V., O’Valle F., Lerma B.A., Ruiz de Almodóvar C., LópezPeñalver J.J., Nieto A. et al. Human mesenchymal stem cells enhance the systemic effects of radiotherapy. Oncotarget. 2015;6(31):31164–31180. doi: 10.18632/oncotarget.5216.de Araújo Farias V., O’Valle F., Lerma B.A., Ruiz de Almodóvar C., LópezPeñalver J.J., Nieto A. et al. Human mesenchymal stem cells enhance the systemic effects of radiotherapy. Oncotarget. 2015;6(31):31164–31180. doi: 10.18632/oncotarget.5216.Abuodeh Y., Venkat P., Kim S. Systematic review of case reports on the abscopal effect. Curr Probl Cancer. 2016;40(1):25–37. doi: 10.1016/j. currproblcancer.2015.10.001.Abuodeh Y., Venkat P., Kim S. Systematic review of case reports on the abscopal effect. Curr Probl Cancer. 2016;40(1):25–37. doi: 10.1016/j. currproblcancer.2015.10.001.Siva S., Callahan J., MacManus M.P., Martin O., Hicks R.J., Ball D.L. Abscopal [corrected] effects after conventional and stereotactic lung irradiation of non-small-cell lung cancer. J Thorac Oncol. 2013;8(8):e71-2. doi: 10.1097/JTO.0b013e318292c55a.Siva S., Callahan J., MacManus M.P., Martin O., Hicks R.J., Ball D.L. Abscopal [corrected] effects after conventional and stereotactic lung irradiation of non-small-cell lung cancer. J Thorac Oncol. 2013;8(8):e71-2. doi: 10.1097/JTO.0b013e318292c55a.Hamilton A.J., Seid J., Verdecchia K., Chuba P. Abscopal Effect after Radiosurgery for Solitary Brain Metastasis from Non-small Cell Lung Cancer. Cureus. 2018;10(12):e3777. doi: 10.7759/cureus.3777.Hamilton A.J., Seid J., Verdecchia K., Chuba P. Abscopal Effect after Radiosurgery for Solitary Brain Metastasis from Non-small Cell Lung Cancer. Cureus. 2018;10(12):e3777. doi: 10.7759/cureus.3777.Chuang C.H., Hsu J.F., Shen Y.T., Yang C.J. Regression of a metastatic lung mass after receiving whole brain irradiation: Can the abscopal effect cross the blood-brain barrier? Asia Pac J Clin Oncol. 2018;14(5):e548–e550. doi: 10.1111/ajco.13051.Chuang C.H., Hsu J.F., Shen Y.T., Yang C.J. Regression of a metastatic lung mass after receiving whole brain irradiation: Can the abscopal effect cross the blood-brain barrier? Asia Pac J Clin Oncol. 2018;14(5):e548–e550. doi: 10.1111/ajco.13051.Okwan-Duodu D., Pollack B.P., Lawson D., Khan M.K. Role of radiation therapy as immune activator in the era of modern immunotherapy for metastatic malignant melanoma. Am J Clin Oncol. 2015;38(1):119–125. doi: 10.1097/COC.0b013e3182940dc3.Okwan-Duodu D., Pollack B.P., Lawson D., Khan M.K. Role of radiation therapy as immune activator in the era of modern immunotherapy for metastatic malignant melanoma. Am J Clin Oncol. 2015;38(1):119–125. doi: 10.1097/COC.0b013e3182940dc3.Bitran J. The Abscopal Effect Exists in Non-small Cell Lung Cancer: A Case Report and Review of the Literature. Cureus. 2019;11(2):e4118. doi: 10.7759/cureus.4118.Bitran J. The Abscopal Effect Exists in Non-small Cell Lung Cancer: A Case Report and Review of the Literature. Cureus. 2019;11(2):e4118. doi: 10.7759/cureus.4118.Liu Y., Dong Y., Kong L., Shi F., Zhu H., Yu J. Abscopal effect of radiotherapy combined with immune checkpoint inhibitors. J Hematol Oncol. 2018;11(1):104. doi: 10.1186/s13045-018-0647-8.Liu Y., Dong Y., Kong L., Shi F., Zhu H., Yu J. Abscopal effect of radiotherapy combined with immune checkpoint inhibitors. J Hematol Oncol. 2018;11(1):104. doi: 10.1186/s13045-018-0647-8.Shi F., Wang X., Teng F., Kong L., Yu J. Abscopal effect of metastatic pancreatic cancer after local radiotherapy and granulocytemacrophage colony-stimulating factor therapy. Cancer Biol Ther. 2017;18(3):137–141. doi: 10.1080/15384047.2016.1276133.Shi F., Wang X., Teng F., Kong L., Yu J. Abscopal effect of metastatic pancreatic cancer after local radiotherapy and granulocytemacrophage colony-stimulating factor therapy. Cancer Biol Ther. 2017;18(3):137–141. doi: 10.1080/15384047.2016.1276133.Deplanque G., Shabafrouz K., Obeid M. Can local radiotherapy and IL-12 synergise to overcome the immunosuppressive tumor microenvironment and allow “in situ tumor vaccination”? Cancer Immunol Immunother. 2017;66(7):833–840. doi: 10.1007/s00262-017-2000-4.Deplanque G., Shabafrouz K., Obeid M. Can local radiotherapy and IL-12 synergise to overcome the immunosuppressive tumor microenvironment and allow “in situ tumor vaccination”? Cancer Immunol Immunother. 2017;66(7):833–840. doi: 10.1007/s00262-017-2000-4.

The authors declare that there are no conflicts of interest present.