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第56回・2018年・横浜
 

アブスコパル効果(abscopal effect)と思われる腫瘍縮小効果を示した腟癌の1例

演題番号 : P30-3

[筆頭演者]
演者)河合 要介:1 
[共同演者]
鈴木 邦昭:1、山田 友梨花:1、尾瀬 武志:1、窪川 芽衣:1、嶋谷 拓真:1、植草 良輔:1、國島 温志:1、甲木 聡:1、長尾 有佳里:1、藤田 啓:1、矢吹 淳司:1、梅村 康太:1、岡田 真由美:1、河井 通泰:1

1:豊橋市民病院・産婦人科

 

Background: The abscopal effect is defined as the clearance of distant tumors after applying localized irradiation to a particular tumor site. It has been proposed that a mechanism for the abscopal effect might be the activation of the immune system, which leads to immunogenic tumor cell death. We report a case of the abscopal effect in squamous cell carcinoma of the vagina with metastasis to para-aortic lymph node.
Case: A 74-year-old Japanese woman who had undergone hysterectomy at 45 years old came to our hospital due to irregular vaginal bleeding and genital pain. Large exogenous hard lesion developed on the nearby prolapsed vaginal wall. Vaginal wall biopsy revealed squamous cell carcinoma. PET/CT revealed the involvement of para-aortic, pelvic and inguinal lymph nodes. Based on these findings, the case was diagnosed as vaginal cancer, cT2N1M1, Stage IV. Chemotherapy was not administered because of the patient's strong wish. She received radiation therapy alone (48.6 Gy/27 fr), and achieved complete response. CT performed one month after starting radiotherapy showed a remarkable reduction of the mass and pelvic and inguinal lymph node metastasis. In addition to this, we observed spontaneous shrinking of the para-aortic lymph node metastasis, which was located out of the radiation field. No chemotherapy was given during the period.
Conclusion: Irradiation of the whole pelvic resulted in tumor mass regression in the untreated para-aortic lymph node metastasis. We observed a rare radiation-induced abscopal effect in a site distant from the area of irradiation. Radiotherapy might represent a potential candidate for a synergistic combination with immunotherapy, by improving the immunogenicity of tumors and by enhancing local and systemic immune effects. A combination of immune-checkpoint inhibitors and radiation therapy represents a promising therapeutic strategy in part mediated by the abscopal effect.

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臓器別:その他

手法別:放射線治療

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