Journal of Cancer Research and Therapeutics

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

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


Hui Xu1, Wenqiao Sun2, Yongmei Kong1, Yahan Huang1, Zhigang Wei1, Licheng Zhang2, Jing Liang1, Xin Ye1,  
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

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

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.



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;16:1718-1721


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 Jul 30 ];16:1718-1721
Available from: https://www.cancerjournal.net/text.asp?2020/16/7/1718/308759


Full Text



 Introduction



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



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}

 Discussion



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



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.

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