免疫治疗和肺部消融治疗时代非小细胞肺癌远隔效应的定义：叙述性综述
Defining the abscopal effect in non-small cell lung cancer in the era of immunotherapy and lung ablation treatment: a narrative review.
摘要(中文译文)
远隔效应最早于1953年被描述，是指局部治疗后远处未照射肿瘤的消退。历史上该现象被认为罕见，但随着免疫治疗及非小细胞肺癌（NSCLC）局部治疗的引入，人们对这一现象的兴趣日益增加。本综述总结了目前关于NSCLC在放疗、肺消融及联合多模式治疗后背隔效应的病理生理学、临床观察及评估方面的证据。临床前及早期临床研究表明，放疗及消融技术（如冷冻消融、微波消融和脉冲电场治疗）可诱导免疫原性细胞死亡，导致肿瘤抗原及危险相关分子模式的释放，从而激活全身性抗肿瘤免疫应答。当与免疫检查点抑制剂联合使用时，这些局部治疗可能增强免疫激活，有望改善局部及远处肿瘤的控制。然而，对远隔效应的识别仍不一致，很大程度上归因于传统疗效评估标准的局限性。尽管iRECIST部分捕捉了非典型缓解模式，但大多数临床试验并未系统记录明确的照射野外肿瘤消退。现有证据主要来自临床前模型及早期研究，提示NSCLC中远隔效应的真实发生率可能被低估。据此，我们提出NSCLC远隔效应的工作定义：在局部治疗伴或不伴全身治疗后，远离原治疗部位的一个或多个未照射病灶出现消退（按iRECIST评估为完全缓解或部分缓解），并经4-8周内的随访影像学确认。建立标准化的术语和评估标准对于在未来NSCLC研究和临床实践中准确识别和整合潜在的远隔效应至关重要。
Abstract
The abscopal effect, first described in 1953, refers to the regression of distant, non-irradiated tumors following localized therapy. Historically considered rare, interest in this phenomenon has increased with the introduction of immunotherapy and local treatments for non-small cell lung cancer (NSCLC). This review summarizes the current evidence on the pathophysiology, clinical observations, and assessment of the abscopal effect in NSCLC following radiotherapy, lung ablation, and combined multimodality therapies. Preclinical and early clinical studies suggest that radiotherapy and ablative techniques such as cryoablation, microwave ablation, and pulsed electric field therapy may induce immunogenic cell death, leading to the release of tumor antigens and danger-associated molecular patterns that can activate systemic antitumor immune responses. When combined with immune checkpoint inhibitors, these local therapies may enhance immune activation, potentially improving both local and distant tumor control. However, recognition of abscopal effects remains inconsistent, largely due to limitations of conventional response assessment criteria. While iRECIST partly captures atypical response patterns, unequivocal out-of-field tumor regression is not systematically recorded in most clinical trials. The available evidence, primarily from preclinical models and early-phase studies, suggests that the true incidence of abscopal effects in NSCLC may be underrecognized. Accordingly, we propose a working definition of the abscopal effect in NSCLC: the regression (complete or partial response by iRECIST) of one or more non-irradiated lesions distant from the primary treatment site, occurring after localized therapy with or without systemic treatment, and confirmed by follow-up imaging within 4-8 weeks. Establishing standardized terminology and assessment criteria will be essential for accurately identifying and integrating potential abscopal responses in future NSCLC research and clinical practice.
如何引用
AMA
Illaa Smesseim, Phillip N Perez, Abraham Chachoua, Benjamin T Cooper, Daniel H Sterman. Defining the abscopal effect in non-small cell lung cancer in the era of immunotherapy and lung ablation treatment: a narrative review.. Frontiers in medicine. 2026; doi:10.3389/fmed.2026.1804711.
APA
Illaa Smesseim, Phillip N Perez, Abraham Chachoua, Benjamin T Cooper, Daniel H Sterman (2026). Defining the abscopal effect in non-small cell lung cancer in the era of immunotherapy and lung ablation treatment: a narrative review.. Frontiers in medicine. https://doi.org/10.3389/fmed.2026.1804711
GB/T 7714
Illaa Smesseim, Phillip N Perez, Abraham Chachoua, Benjamin T Cooper, Daniel H Sterman. Defining the abscopal effect in non-small cell lung cancer in the era of immunotherapy and lung ablation treatment: a narrative review.[J]. Frontiers in medicine, 2026 doi:10.3389/fmed.2026.1804711.
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