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CASE REPORT
Year : 2020  |  Volume : 16  |  Issue : 7  |  Page : 1718-1721

Immune abscopal effect of microwave ablation for lung metastases of endometrial carcinoma


1 Department of Oncology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Lung Cancer Institute, Weihai, Shandong, China
2 Department of Minimally Invasive Interventional Oncology, Weihai Municipal Hospital Affiliated to Shandong University, Weihai, Shandong, China

Date of Submission22-Sep-2020
Date of Decision27-Dec-2020
Date of Acceptance30-Dec-2020
Date of Web Publication9-Feb-2021

Correspondence Address:
Jing Liang
Department of Oncology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Lung Cancer Institute, Jingshi Road, Jinan, Shandong Province, 250014
China
Licheng Zhang
Department of Minimally Invasive Interventional Oncology, Weihai Municipal Hospital Affiliated to Shandong University, Heping Road, Huancui District, Weihai City, 264200
China
Xin Ye
Department of Oncology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Lung Cancer Institute, Jingshi Road, Jinan, Shandong Province, 250014
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jcrt.JCRT_1399_20

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 > Abstract 


Increasing evidence support that microwave ablation (MWA) induces spontaneous abscopal regression of the tumor, also called as the abscopal effect. Although the abscopal effect after MWA is a rare event, several studies have suggested that this effect is the result of the activation of the immune system induced by the death of immunogenic tumor cells. Here, we have presented the case of a 65-year-old woman with primary endometrial cancer who developed bilateral pulmonary metastases. After local MWA of one lesion in her right lung, progressive regression of the other lesions in the right and left lungs was recorded. This case supports the hypothesis that the abscopal effect is attributable to the activation of the systemic immune response.

Keywords: Abscopal effect, endometrial carcinoma, microwave ablation


How to cite this article:
Xu H, Sun W, Kong Y, Huang Y, Wei Z, Zhang L, Liang J, Ye X. Immune abscopal effect of microwave ablation for lung metastases of endometrial carcinoma. J Can Res Ther 2020;16:1718-21

How to cite this URL:
Xu H, Sun W, Kong Y, Huang Y, Wei Z, Zhang L, Liang J, Ye X. Immune abscopal effect of microwave ablation for lung metastases of endometrial carcinoma. J Can Res Ther [serial online] 2020 [cited 2021 Mar 8];16:1718-21. Available from: https://www.cancerjournal.net/text.asp?2020/16/7/1718/308759

Hui Xu and Wenqiao Sun contribute equally to this work.





 > Introduction Top


Microwave ablation (MWA), as a precise and minimally invasive treatment strategy, has been increasingly used for cancer treatment, such as for the cancer of lung,[1],[2],[3],[4],[5],[6] liver,[7],[8] kidney,[9],[10] and bone tumor,[11],[12] among others. MWA can induce a phenomenon called the “abscopal effect,” which has been observed in the treatment of metastatic cancer, where distant tumors show regression without MWA after the administration of local MWA therapy to a specific tumor site. The underlying mechanism of this response remains unclear until date. Several studies have suggested that this effect may be related to the immune response produced by the body.[13],[14] The effect of thermal ablation mainly depends on its direct anticancer effect and the degree of ablation of the target tumor. In recent years, indirect systemic effects, especially, the antitumor immune response induced by thermal ablation, have also drawn attention.[15],[16] If this approach can induce a good immune response, its general effect on all tumor lesions would be evident. Several preclinical and clinical studies have shown that thermal ablation can enhance the host antitumor immunity and produce abscopal effects. These effects are even more pronounced when combined with immunotherapy.[17] DNA damage and immunogenic cell death induced by MWA lead to the activation of dendritic cells in vivo, thereby initiating tumor-specific T-cell responses.[18] Here, we have described the case of a patient with bilateral pulmonary metastases after endometrial cancer surgery. After MWA of one of her lesions, the other lesions were also affected.


 > Case Report Top


A 65-year-old woman underwent extensive hysterectomy with bilateral adnexectomy and pelvic lymphadenectomy 6 years ago. Her postoperative pathology revealed moderately differentiated adenocarcinoma in the endometrium. Accordingly, three cycles of paclitaxel combined with carboplatin regimen were administered postoperatively. After 3 years of this treatment, no obvious cause of intermittent hemoptysis was noted. The patient was admitted to our hospital, and her chest computed tomography (CT) revealed multiple round nodule foci in both the lungs, with a maximum of 2.7 cm anceme [Figure 1]a and [Figure 1]b, suggesting multiple pulmonary metastases. The patient received gemcitabine combined with cisplatin and docetaxel combined with cisplatin for six cycles, followed by the combination with endocrine therapy for 4 months. The patient presented with aggravation of repeated hemoptysis for 1 week, and hemoptysis reached 20 mL once. Her CT scan indicated pulmonary metastases progression. The two larger lesions were of sizes 3.0 cm × 2.6 cm in the right hilum and 2.8 cm × 2.5 cm in the left hilum [Figure 1]c and [Figure 1]d. Meanwhile, both carcinoembryonic antigen (CEA) and CEA-125 existed within the normal levels (CEA: 3.2 ng/mL, CEA-125: 2.2 ng/mL). The patient's hemoptysis was considered to be caused by the metastatic lesion present near the right hilum. Therefore, CT-guided biopsy and MWA were performed simultaneously. The patient was placed in the prone position and local anesthesia with 1% lidocaine was applied. The puncture point was located at the third intercostal space 3.0 cm outside of the posterior midline. After CT-guided biopsy, a MWA antenna was punctured into the tumor in a step-wise manner. Then, the ablation was conducted [Figure 1e, ablation parameter: 60 W × 5 min]. The patients refused to undertake any treatment, including chemotherapy, or endocrine therapy for cancer from an unknown cause. After 1 month, her CT revealed a cavity in the right lung lesion without enhancement. The left lung lesion was slightly reduced with an uneven enhancement. Other small lesions in the lung decreased and shrunk [Figure 1]f and [Figure 1]g. After 6 months, the right lung lesion shrunk without any enhancement. The left lung lesion was significantly reduced without any enhancement. Other small lung lesions disappeared [Figure 1]h and [Figure 1]i. After 9 months, the right lung lesion was reduced to a fibrostrip without any enhancement. The left lung lesion had also disappeared without any enhancement [Figure 1]j and [Figure 1]k. The right lung lesion formed fibrous scar after 18 months, the left lung lesion disappeared, and no new metastasis developed in either of the lungs [Figure 1]l and [Figure 1]m. After 3 years of the ablation, the lesions on the right lung almost disappeared, and no metastatic lesions were noted in other parts of the lung [Figure 1]n and [Figure 1]o. The patient survived with a high quality of life.
Figure 1: The progression of pulmonary metastases pre- and postablation. (a and b) Before chemotherapy, endocrine therapy (for multiple pulmonary metastases in both the lungs, maximum 2.7 cm, indicated by arrow); (c and d) After 4 months of chemotherapy and endocrine therapy (progression of disease, indicated by arrow); (e) The microwave antenna was punctured into the lesion (right hilum, ablation parameter: 60 W × 5 min, indicated by arrow); (f and g) After 1 month of ablation, CT showed a cavity in the right lung lesion without any enhancement. The left lung lesion was slightly reduced with an uneven enhancement. Other small lesions in the lung decreased and shrunk; (h and i) After 6 months of the ablation, the right lung lesion shrunk without any enhancement. The left lung lesion was significantly reduced without any enhancement. Other small lung lesions disappeared; (j and k) After 9 months, the right lung lesion was reduced to a fibrostrip without any enhancement. The left lung lesion disappeared; (l and m) After 18 months of ablation, the right lung lesion formed fibrous scar, the left lung lesion disappeared, and no new metastasis developed in either lungs; (n and o) After 3 years of ablation, the lesions on the right lung almost disappeared and no metastatic lesions were noted in other parts of the lung

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 > Discussion Top


The present case patient showed multiple pulmonary metastases from endometrial carcinoma and failed to respond to the chemotherapy and endocrine therapy. MWA was performed on a metastatic lesion in the right lung, and the other metastatic lesions gradually disappeared. After 3 years of follow-up, no new metastatic lesions were detected. The reason for this outcome is believed to be the abscopal effect caused by the stimulation of self-antitumor immunity after MWA.

However, the mechanism of the abscopal effect caused by MWA remains unclear. Several possible mechanisms have been suggested. The first one is that the destruction of the tumor by thermal ablation induces the release of tumor antigens, which in turn activates the immune system, eliciting a response from the body's antitumor immune system.[14],[19] The second possible mechanism is the release of pro-inflammatory cytokines, especially interleukin (IL)-1 and IL-8 after the ablation. IL-1 and IL-8 can promote type-I helper T-cell response, promote the activation of dendritic cells and cytotoxic T-lymphocytes, and thereby kill the tumor cells.[18] In addition, the involvement of P53 and transforming growth factor also cause the same effect.[20],[21] There may also be other mechanisms that have not been proposed yet. Recent studies have, however, shown that the immune response induced by MWA is crucial to enhance the antitumor ability. Meanwhile, MWA has also been reported to treat some cancers through induction of the immunogenic cell death.[22] Whether we can improve the efficacy of a systemic response through immunotherapy combined with MWA should be explored in the future as this approach seems to offer significant benefit in terms of both treatment and prognosis for patients with primary and metastatic tumors. In the treatment of cancer, MWA combined with immunotherapy may thus be a promising treatment.


 > Conclusion Top


In the present report, we have described a rare abscopal effect in a patient in whom MWA of one lesion was followed by a marked regression of the lesion at other sites. As mentioned earlier, further studies are crucial to validate whether this systemic response occurs as a result of the activation of the antitumor immune response induced by MWA.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
 > References Top

1.
Healey TT, March BT, Baird G, Dupuy DE. Microwave Ablation for Lung Neoplasms: A Retrospective Analysis of Long-Term Results. J Vasc Interv Radiol 2017;28:206-11.  Back to cited text no. 1
    
2.
Ye X, Fan W, Wang H, Wang J, Wang Z, Gu S, et al. Expert consensus workshop report: Guidelines for thermal ablation of primary and metastatic lung tumors (2018 edition). J Cancer Res Ther 2018;14:730-44.  Back to cited text no. 2
    
3.
Liu J, Huang W, Wu Z, Wang Z, Ding X. The application of computed tomography-guided percutaneous coaxial biopsy combined with microwave ablation for pulmonary tumors. J Cancer Res Ther 2019;15:760-5.  Back to cited text no. 3
    
4.
Tafti BA, Genshaft S, Suh R, Abtin F. Lung Ablation: Indications and Techniques. Semin Intervent Radiol 2019;36:163-75.  Back to cited text no. 4
    
5.
Yang X, Ye X, Lin Z, Jin Y, Zhang K, Dong Y, et al. Computed tomography-guided percutaneous microwave ablation for treatment of peripheral ground-glass opacity-Lung adenocarcinoma: A pilot study. J Cancer Res Ther 2018;14:764-71.  Back to cited text no. 5
    
6.
Wei Z, Yang X, Ye X, Feng Q, Xu Y, Zhang L, et al. Microwave ablation plus chemotherapy versus chemotherapy in advanced non-small cell lung cancer: a multicenter, randomized, controlled, phase III clinical trial. Eur Radiol 2020;30:2692-702.  Back to cited text no. 6
    
7.
Soliman AF, Abouelkhair MM, Hasab Allah MS, El-Kady NM, Ezzat WM, Gabr HA, et al. Efficacy and Safety of Microwave Ablation (MWA) for Hepatocellular Carcinoma (HCC) in Difficult Anatomical Sites in Egyptian Patients with Liver Cirrhosis Asian Pac J Cancer Prev 2019;20:295-301.  Back to cited text no. 7
    
8.
Chen X, Fu C, Wang Y, Wu Q, Meng X, Xu K. Mitochondria-targeting nanoparticles for enhanced microwave ablation of cancer. Nanoscale 2018;10:15677-85.  Back to cited text no. 8
    
9.
Floridi C, De Bernardi I, Fontana F, Muollo A, Ierardi AM, Agostini A, et al. Microwave ablation of renal tumors: state of the art and development trends. Radiol Med 2014;119:533-40.  Back to cited text no. 9
    
10.
Krokidis ME, Kitrou P, Spiliopoulos S, Karnabatidis D, Katsanos K. Image-guided minimally invasive treatment for small renal cell carcinoma. Insights Imaging 2018;9:385-90.  Back to cited text no. 10
    
11.
Zheng K, Yu X, Hu Y, Zhang Y, Wang Z, Wu S, et al. Clinical Guideline for Microwave Ablation of Bone Tumors in Extremities. Orthop Surg 2020;12:1036-44.  Back to cited text no. 11
    
12.
Ma L, Zhou Y, Zhu Y, Lin Z, Chen L, Zhang Y, et al. 3D printed personalized titanium plates improve clinical outcome in microwave ablation of bone tumors around the knee. Sci Rep 2017;7:7626.  Back to cited text no. 12
    
13.
Zhou Y, Xu X, Ding J, Jing X, Wang F, Wang Y, et al. Dynamic changes of T-cell subsets and their relation with tumor recurrence after microwave ablation in patients with hepatocellular carcinoma. J Cancer Res Ther 2018;14:40-5.  Back to cited text no. 13
    
14.
Wu F. Heat-Based Tumor Ablation: Role of the Immune Response. Adv Exp Med Biol 2016;880:131-53.  Back to cited text no. 14
    
15.
Li L, Wang W, Pan H, Ma G, Shi X, Xie H, et al. Microwave ablation combined with OK-432 induces Th1-type response and specific antitumor immunity in a murine model of breast cancer. J Transl Med 2017;15:23.  Back to cited text no. 15
    
16.
Zhu J, Yu M, Chen L, Kong P, Li L, Ma G, et al. Enhanced antitumor efficacy through microwave ablation in combination with immune checkpoints blockade in breast cancer: A pre-clinical study in a murine model. Diagn Interv Imaging 2018;99:135-42.  Back to cited text no. 16
    
17.
Takaki H, Cornelis F, Kako Y, Kobayashi K, Kamikonya N, Yamakado K. Thermal ablation and immunomodulation: From preclinical experiments to clinical trials. Diagn Interv Imaging 2017;98:651-9.  Back to cited text no. 17
    
18.
Ali MY, Grimm CF, Ritter M, Mohr L, Allgaier HP, Weth R, et al. Activation of dendritic cells by local ablation of hepatocellular carcinoma. J Hepatol 2005;43:817-22.  Back to cited text no. 18
    
19.
Haen SP, Pereira PL, Salih HR, Rammensee HG, Gouttefangeas C. More than just tumor destruction: immunomodulation by thermal ablation of cancer. Clin Dev Immunol 2011;2011:160250.  Back to cited text no. 19
    
20.
Chen L, Wang M, Lin Z, Yao M, Wang W, Cheng S, et al. Mild microwave ablation combined with HSP90 and TGF-β1 inhibitors enhances the therapeutic effect on osteosarcoma. Mol Med Rep 2020;22:906-14.  Back to cited text no. 20
    
21.
Hohenforst-Schmidt W, Zarogoulidis P, Stopek J, Vogl T, Hübner F, Turner JF, et al. DDMC-p53 gene therapy with or without cisplatin and microwave ablation. Onco Targets Ther 2015;8:1165-73.  Back to cited text no. 21
    
22.
Yu Z, Geng J, Zhang M, Zhou Y, Fan Q, Chen J. Treatment of osteosarcoma with microwave thermal ablation to induce immunogenic cell death. Oncotarget 2014;5:6526-39.  Back to cited text no. 22
    


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