The abscopal effect was described more than 50 years ago and is a phenomenon in which radiation therapy promotes the regression of metastatic foci remote from the site of radiation. For decades, this effect has been described as a rare, unexplained phenomenon in patients receiving radiation therapy. Today, the abscopal effect is still an exceptional phenomenon: the mechanism underlying it is still not fully understood. It is believed that the abscopal effect is most likely associated with systemic immune responses that occur under the influence of radiation therapy.We present the case of a 63-year-old patient with advanced peripheral cancer of the upper lobe of the left lung, disease progression in the form of metastatic brain lesions and regression of tumor foci in the lungs after radiation therapy to the brain, while the patient did not receive additional treatment in the form of immunotherapy.The article examines the history of the abscopal effect, an attempt is made to understand the mechanisms of its occurrence, which can help to further improve the results of treatment of patients with NSCLC using radiation therapy and modern approaches to complex cancer treatment.
Purpose: To evaluate the possibility of multiparametric MRI in the differential diagnosis of benign adrenal adenomas and adrenal metastases.Material and methods: In our study we evaluated 27 adenomas and 13 adrenal metastases using MRI in 35 patients who underwent examination and treatment at the basis of the N.N. Blokhin National Research Center of Oncology during the follow-up period from 2019 to 2021. The following parameters were evaluated: contours, homogeneity (homogeneous and heterogeneous), T2-weighted SI ratio (isointensive, moderately hyperintensive or sharply hyperintensive) relative to muscle and spleen, signal intensity (SI) decrease on chemical-shift MRI, measurement of the chemical-shift SI index, adrenal-to-spleen SI ratio, areas under the ROC curve (AUC) for contrast-enhanced MRI, absolute and relative percentage wash-out. Sensitivity, specificity, and positive and negative predictive values were calculated. DWI with b-values 400 and 800 s/mm2 and ADCs imaging were measured in adrenal lesions.Results: Metastases were subjectively more heterogeneous than adenomas (76.9 % vs 63 % of cases, p = 0.0181). Adenomas had higher T2-weighted SI (average value = 228; range from 91 to 732) than metastases (average value = 331; range from 114 to 581), both quantitatively (p = 0.0326) and subjectively by visual assessment (p = 0.0171).According to the T1-WI out-of-phase data, a more intense MR signal was observed in metastases (average value 162; range from 102 to 242) compared with adenomas (average value = 74; range from 17 to 183) (p < 0.0001), which was confirmed by normalization to muscle (p < 0.0001) and spleen (p = 0.0002). Adrenal metastases were characterized by a significantly lower chemical shift index (average value = 3.8; range from –16.4 to 47.8; p < 0.0001) compared with adenomas (average value 55.4; range from –4.2 to 85.5), and a higher chemical shift index in the ratio adrenal gland/spleen (p = 0.0079). There were no significant difference in the value of ADC-cards of adenomas and adrenal metastases. However, a higher level of SI on DWI at b = 800 s/ mm2 without normalization (p = 0.0262) and with normalization to muscle (p = 0.0064) and spleen (p = 0.0007) was evaluated in metastases, as well as on DWI at b = 400 s/mm2 with normalization for muscle (p = 0.0086) and spleen (p = 0.035). On native T1-WI FS, there was a lower level of SI revealed in adenomas compared to adrenal metastases (p = 0.0025), which was confirmed by normalization to the muscle (p = 0.0028) and spleen (p = 0.0035). In the venous and delayed phases of scanning the SI in adenomas was also lower than in metastases both without normalization (p = 0.0123 and p = 0.007, respectively), and with normalization to the muscle (p = 0.013 and p = 0.0011, respectively) and the spleen (p = 0.0084 and p = 0.0012, respectively). However, the SI in the arterial phase of scanning with and without normalization, the accumulation of MRCS in all phases of MRI scanning, the absolute and relative percentage wash-out of MRCS and the area under the MRCS accumulation curve in the groups had no statistically significant difference.
Tumoural portal vein thrombosis is a rare manifestation in gastric cancer. There is no reliable information in the worldwide literature on the overall survival of this category of patients. Few clinical cases have been described. This is a clinical case: a patient has diagnosed with body and antral gastric cancer complicated by tumour thrombosis of the portal vein and ingrowth into the pancreas. The clinical case described by the authors demonstrates yours the relevance of a number of issues. How can we namely be staging, treatment options and prognosis. The aim of this publication is to draw attention to a rare but common category of patient in oncologists’ clinical practice.
Objective. To compare the informative value of using dynamic magnetic resonance imaging (MRI) and diffusion-weighted MRI (DW-MRI) in patients with breast liver metastasis during chemotherapy.Material and methods. The investigation enrolled 30 patients with breast liver metastasis during their treatment. The results of standard intravenous contrast-enhanced abdominal MRI studies (by evaluating the liver in the arterial, venous, and delayed phases) were compared with those of DW-MRI with different B-factor values (50, 400 and 800 sec/mm2).Results. Comparison of the findings of initial studies prior to chemotherapy (those of only dynamic intravenous contrast-enhanced MRI and only DW-MRI) revealed a complete correspondence with the number of detected foci in 10 patients. Ten patients had a larger number of metastatic foci at DW-MRI than at intravenous contrast-enhanced MRI, in the aggregate by 44 foci more (of them 36 foci measured less than 1 cm). The remaining 10 of the 30 patients were found to have multiple, unquantifiable (more than 20–40) metastatic foci of various sizes (1–6 cm) at both intravenous contrast-enhanced MRI and DW-MRI. Nineteen of the 30 patients were followed up during their chemotherapy. Seven of the 19 patients showed a stabilized liver metastatic process that was similarly evidenced by both techniques. Eleven of the 19 patients were observed to have a progressive metastatic process that was reflected by the similar increase in the number and size of metastases in 5 of the 11 patients, as shown by both of the above techniques. In the remaining 6 of the 11 patients, the number of newly detected liver tumors proved to be larger at DW-MRI than at intravenous contrast-enhanced MRI. Both techniques showed that the last patient of the 19 cases had a decrease in the number of small liver metastases that maintained their sizes (less than 1 cm).Conclusion. DW-MRI has been shown to be much more effective in detecting metastases than conventional intravenous contrast-enhanced MRI, which necessitates the inclusion of this technique in standard abdominal MRI protocols for patients with liver metastasis.
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