放射治疗中的远隔效应：免疫机制与临床进展
Abscopal Effect in Radiation Therapy: The Immune Mechanisms and Clinical Advances.
摘要(中文译文)
远隔效应是局部放疗引起的全身性抗肿瘤反应，在免疫治疗时代已成为核心研究焦点。临床证据表明，局部放疗可诱导远处未照射转移灶的消退，包括完全缓解的病例。然而，该效应仍难以预测，临床结局差异显著，从完全消退到矛盾性进展均有报道。这种异质性的机制基础以及增强远隔效应的最佳策略仍未完全阐明。本综述将现有证据整合为一个围绕三阶段免疫级联反应组织的机制框架：启动、协调与执行。我们探讨了肿瘤内在因素、放疗参数及生物标志物如何塑造这一级联反应。随后，我们评估了临床试验格局，并讨论了这些机制见解如何为患者选择、治疗时机及放射免疫联合策略提供依据。至关重要的是，我们建立了一个双向框架，将有利的远隔反应与促肿瘤的“坏隔效应”区分开来，后者指放疗通过免疫抑制通路矛盾性地促进远处进展。通过阐明这些机制与变量，本综述为改进未来临床试验设计以及推动远隔效应从偶发现象转变为可预测的治疗策略提供了框架。
Abstract
The abscopal effect is a systemic antitumor response to localized radiotherapy (RT) that has emerged as a central focus in the era of immunotherapy. Clinical evidence demonstrates that local RT can induce regression of distant, nonirradiated metastases, including cases of complete remission. However, the effect remains unpredictable, with marked variation in clinical outcomes ranging from complete regression to paradoxical progression. The mechanistic basis for this heterogeneity and optimal strategies to enhance abscopal effects remain incompletely understood. This review synthesizes current evidence into a mechanistic framework organized around a three-stage immune cascade: ignition, orchestration, and execution. We examine how tumor-intrinsic factors, RT parameters, and biomarkers shape this cascade. We then appraise the clinical trial landscape and discuss how these mechanistic insights may inform patient selection, treatment timing, and radioimmunotherapy combination strategies. Critically, we establish a bidirectional framework distinguishing the favorable abscopal response from the pro-tumorigenic badscopal effect, in which RT paradoxically promotes distant progression through immunosuppressive pathways. By clarifying these mechanisms and variables, this review offers a framework for improving future clinical trial design and advancing the abscopal effect from a sporadically observed phenomenon to a predictable therapeutic strategy.
如何引用
AMA
Yihong Dong, Moran Chen, Xupeng Hou, Xiaoya Tang, Xiaoli Yu, Jing Liu. Abscopal Effect in Radiation Therapy: The Immune Mechanisms and Clinical Advances.. MedComm. 2026; doi:10.1002/mco2.70932.
APA
Yihong Dong, Moran Chen, Xupeng Hou, Xiaoya Tang, Xiaoli Yu, Jing Liu (2026). Abscopal Effect in Radiation Therapy: The Immune Mechanisms and Clinical Advances.. MedComm. https://doi.org/10.1002/mco2.70932
GB/T 7714
Yihong Dong, Moran Chen, Xupeng Hou, Xiaoya Tang, Xiaoli Yu, Jing Liu. Abscopal Effect in Radiation Therapy: The Immune Mechanisms and Clinical Advances.[J]. MedComm, 2026 doi:10.1002/mco2.70932.
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