Clinical evidence of abscopal effect in cutaneous squamous cell carcinoma treated with diffusing alpha emitters radiation therapy: a case report

Salvatore Bellia; Giacomo Feliciani; Massimo Duca; Manuela Monti; Valentina Turri; Anna Sarnelli; Antonino Romeo; Itzhak Kelson; Yona Keisari; Aron Popovtzer; Toni Ibrahim; Giovanni Paganelli; Ignazio Stanganelli

doi:10.5114/jcb.2019.88138

eISSN: 2081-2841
ISSN: 1689-832X

Journal of Contemporary Brachytherapy

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abstract:

Case report

Clinical evidence of abscopal effect in cutaneous squamous cell carcinoma treated with diffusing alpha emitters radiation therapy: a case report

Salvatore Roberto Bellia

¹

,

Giacomo Feliciani

²

,

Massimo Del Duca

¹

,

Manuela Monti

³

,

Valentina Turri

⁴

,

Anna Sarnelli

²

,

Antonino Romeo

¹

,

Itzhak Kelson

⁵

,

Yona Keisari

⁶

,

Aron Popovtzer

⁷

,

Toni Ibrahim

⁸

,

Giovanni Paganelli

⁹

,

Ignazio Stanganelli

¹⁰

Department of Radiotherapy, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola (FC), Italy
Department of Medical Physics, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola (FC), Italy
Biostatistics and Clinical Experimentation, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola (FC), Italy
Medical Direction, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola (FC), Italy
School of Physics and Astronomy, Tel Aviv University, Exact Sciences, Tel Aviv, Israel
Sackler Faculty of Medicine, Tel Aviv University, Clinical Microbiology and Immunology, Tel Aviv, Israel
Department of Radiation Oncology, David of Cancer Center and Sackler Faculty of Medicine, Israel University, Tel Aviv, Israel
Osteoncology and Rare Tumors Center CDO-TR, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola (FC), Italy
Nuclear Medicine Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola (FC), Italy
Skin Cancer Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola (FC), Italy

J Contemp Brachytherapy 2019; 11, 5: 449–457

DOI: https://doi.org/10.5114/jcb.2019.88138

Online publish date: 2019/09/20

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AMA

Bellia SR, Feliciani G, Duca MD, et al. Clinical evidence of abscopal effect in cutaneous squamous cell carcinoma treated with diffusing alpha emitters radiation therapy: a case report. Journal of Contemporary Brachytherapy. 2019;11(5):449-457. doi:10.5114/jcb.2019.88138.

APA

Bellia, S. R., Feliciani, G., Duca, M. D., Monti, M., Turri, V.,  & Sarnelli, A. et al. (2019). Clinical evidence of abscopal effect in cutaneous squamous cell carcinoma treated with diffusing alpha emitters radiation therapy: a case report. Journal of Contemporary Brachytherapy, 11(5), 449-457. https://doi.org/10.5114/jcb.2019.88138

Chicago

Bellia, Salvatore R, Giacomo Feliciani, Massimo D Duca, Manuela Monti, Valentina Turri, Anna Sarnelli,  and Antonino Romeo et al. 2019. "Clinical evidence of abscopal effect in cutaneous squamous cell carcinoma treated with diffusing alpha emitters radiation therapy: a case report". Journal of Contemporary Brachytherapy 11 (5): 449-457. doi:10.5114/jcb.2019.88138.

Harvard

Bellia, S., Feliciani, G., Duca, M., Monti, M., Turri, V., Sarnelli, A., Romeo, A., Kelson, I., Keisari, Y., Popovtzer, A., Ibrahim, T., Paganelli, G.,  and Stanganelli, I. (2019). Clinical evidence of abscopal effect in cutaneous squamous cell carcinoma treated with diffusing alpha emitters radiation therapy: a case report. Journal of Contemporary Brachytherapy, 11(5), pp.449-457. https://doi.org/10.5114/jcb.2019.88138

MLA

Bellia, Salvatore et al. "Clinical evidence of abscopal effect in cutaneous squamous cell carcinoma treated with diffusing alpha emitters radiation therapy: a case report." Journal of Contemporary Brachytherapy, vol. 11, no. 5, 2019, pp. 449-457. doi:10.5114/jcb.2019.88138.

Vancouver

Bellia S, Feliciani G, Duca M, Monti M, Turri V, Sarnelli A et al. Clinical evidence of abscopal effect in cutaneous squamous cell carcinoma treated with diffusing alpha emitters radiation therapy: a case report. Journal of Contemporary Brachytherapy. 2019;11(5):449-457. doi:10.5114/jcb.2019.88138.

Purpose
Alpha particle treatments could enhance the probability of an immune response, which can lead to abscopal effects (AE). We report a case of a patient affected by multiple cutaneous squamous cell carcinoma (cSCC). After the treatment with diffusing alpha emitters radiation therapy (DaRT) of one lesion, an AE was observed on at least two distant ones.

Material and methods
We investigated a case of a 65-year-old female patient with multiple synchronous lesions of the skin of lower limbs confirmed by a biopsy. Patient was enrolled in a clinical trial N.CTP-SCC-00 (NCT03015883), with the objective to assess effectiveness of DaRT technique. DaRT is based on the insertion of locally 224Ra-loaded seeds in a clinical target volume (CTV). Treatment plan with positron emission tomography/computed tomography (PET/CT) was used to entirely cover the CTV. Follow-up and biopsy evaluations were employed to outline the patient outcome.

Results
We performed seeds implantation according to the Paris system. At 28th day, an evident lesion shrinkage with a persistent minimal area of hyperkeratosis was noted. 76 days after implantation, a complete remission of the treated lesion was observed and an evident reduction of the area with two more distant lesion, which could be associated to an immune-mediated response. One year after the treatment, a complete remission of treated lesion was observed as well as spontaneous regression of untreated distant ones.

Conclusions
In this study, we reported evidences of an AE in cSCC stimulated by radiation and possibly mediated by immune system. In the next DaRT treatments, our intent is to monitor T-lymphocytes variations in peripheral blood in order to demonstrate indirect activation of the immune system mediated by radiation also in patients with solitary lesions, in which, by definition, an AE cannot be observed.

keywords:

Clinical evidence of abscopal effect in cutaneous squamous cell carcinoma treated with diffusing alpha emitters radiation therapy: a case report

Salvatore Roberto Bellia 1 , Giacomo Feliciani 2 , Massimo Del Duca 1 , Manuela Monti 3 , Valentina Turri 4 , Anna Sarnelli 2 , Antonino Romeo 1 , Itzhak Kelson 5 , Yona Keisari 6 , Aron Popovtzer 7 , Toni Ibrahim 8 , Giovanni Paganelli 9 , Ignazio Stanganelli 10

alpha particles, abscopal effect, cutaneous squamous cell carcinoma, brachytherapy