Abscopal effect in pulmonary carcinoid tumor following ablative stereotactic body radiation therapy: a case report
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(2020) 14:177
CASE REPORT
Open Access
Abscopal effect in pulmonary carcinoid tumor following ablative stereotactic body radiation therapy: a case report Samuel A. Kareff1, Jonathan W. Lischalk2, Rebecca Krochmal3 and Chul Kim4*
Abstract Background: The abscopal effect was described as early as the 1950s, when untreated tumors demonstrated a response after radiation therapy was delivered to an untreated, distant site. The mechanisms underlying this global response to otherwise localized therapy remain unknown, though there is increasing evidence that increased antigen expression following ablative radiotherapy may play a role. Case presentation: We report a case of a 69-year-old African American woman with a history of metastatic typical pulmonary carcinoid with multiple lung nodules who had a significant decrease in size of an untreated left upper lobe nodule after stereotactic body radiation therapy to an oligoprogressive left lower lobe lesion. Conclusions: To our knowledge, this report describes the first case of an abscopal effect in a typical pulmonary carcinoid. Further research is needed regarding the mechanisms responsible for this finding and the role of combining radiation therapy and cancer immunotherapy in patients with pulmonary carcinoid tumors. Keywords: Abscopal effect, Neuroendocrine tumor, Pulmonary carcinoid
Background The abscopal effect was described as early as the 1950s, when untreated tumors demonstrated a response after radiation therapy was delivered to an untreated, distant site. The mechanisms underlying this global response to otherwise localized therapy remain unknown, though there is increasing evidence that increased antigen expression following ablative radiotherapy may play a critical role [1]. Neuroendocrine tumors (NETs) encompass heterogeneous types of neoplasms, including typical carcinoid, atypical carcinoid, and high-grade carcinomas such as small cell neuroendocrine carcinoma and large cell neuroendocrine carcinoma [2]. Typical carcinoids usually exhibit an indolent course, whereas atypical carcinoids are associated with a more aggressive disease * Correspondence: [email protected] 4 Georgetown Lombardi Comprehensive Cancer Center, MedStar Georgetown University Hospital, 3800 Reservoir Road NW, Washington, DC 20007, USA Full list of author information is available at the end of the article
course [2]. We report one case of an abscopal effect in a patient following stereotactic body radiation therapy (SBRT) to a left lower lobe (LLL) carcinoid NET, one of only two known occurrences in the literature, and the first reported in a patient with a typical pulmonary carcinoid. This case report provides insights into potential future therapeutic strategies for NETs, rare entities with overall incidence of carcinoids in the United States estimated at 5.25 cases per 100,000 population, without many established treatment options that have demonstrated efficacy in late-stage clinical trials [3].
Case presentation Our patient was a 69-year-old African American woman wi
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