Regression of pulmonary metastases during radiation to a hypernephroma. Immunity and cancer

Rationale for combination of radiation therapy and immune checkpoint blockers to improve cancer treatment

Radiation therapy for cancer is considered to be immunosuppressive. However, the cellular response after radiation therapy may stimulate or suppress an immune response. The effect may vary with the tumor type and occasionally tumor regressions have been observed outside the irradiated volume, both in animal studies and in the clinic. A renewed interest in the role of immunity for the observed effect of radiation came with the current recognized role of immune checkpoint blockers (ICBs) for control of selected cancer types. We therefore here review preclinical studies and clinical reports on the interaction of ICBs and radiation as a basis for further clinical trials. Some tumor types where the combination of these modalities seems especially promising are also proposed.

Surgical management of pulmonary metastasis

Because of the clarity of roentgenograms, the lungs act as a window to the body through which we can "watch" the growth of a metastatic tumor. By obtaining serial roentgenograms, we can follow the course of a tumor, as well as its response to different forms of therapy. Usually the mass seen on roentgenogram is only part of a larger tumor found in other metastatic deposits. However, Farrell, in a study of 75 cases, found that 15% of the patients had metastatic lesions confined to the lung. Therefore, a finding of pulmonary metastasis should not imply a completely hopeless prognosis. Many patients may benefit from pulmonary resection of a metastatic lesion, either in terms of ultimate cure or by palliation. This report will discuss the pathogenesis of pulmonary metastasis and the surgical approach based on histology and biologic behavior of these tumors and current concepts of oncology as viewed through the study of pulmonary metastasis.

Regression of metastatic hypernephroma

A 71-year-old woman had massive pulmonary metastases from a right hypernephroma, as shown by a chest roentgenogram. Nine days after nephrectomy, there was no roentgenographic evidence of such metastases. This represents the most rapid regression of clear-cell pulmonary metastases ever reported. Metastases reappeared six months postoperatively and the patient died of widespread metastatic disease 18 months after nephrectomy. The unpredictable behavior of metastatic hypernephroma is discussed.

Immunocompetence and spontaneous regression of metastatic renal cell carcinoma

Spontaneous remission of pulmonary metastases from renal cell carcinoma was correlated with a positive response to dinitrochlorobenzene (DNCB). When first seen, the patient was DNCB negative and a chest radiograph showed nodular densities in the right lung and left midlung. Six months after sensitization, the patient had a positive response to DNCB and no evidence of lung metastases. Three mo later, the patient developed brain metastases although X-ray examination showed no pulmonary nodules. A diminished response to DNCB noted over the next several months and chest X ray verified the return of pulmonary metastases.