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Review
. 2009 Jul;10(7):718-26.
doi: 10.1016/S1470-2045(09)70082-8.

Systemic effects of local radiotherapy

Silvia C Formenti  1 , Sandra Demaria
Affiliations
Review

Systemic effects of local radiotherapy

Silvia C Formenti et al. Lancet Oncol. 2009 Jul.

Abstract

Radiotherapy is generally used to treat a localised target that includes cancer. Increasingly, evidence indicates that radiotherapy recruits biological effectors outside the treatment field and has systemic effects. We discuss the implications of such effects and the role of the immune system in standard cytotoxic treatments. Because the effects of chemotherapy and radiotherapy are sensed by the immune system, their combination with immunotherapy presents a new therapeutic opportunity. Radiotherapy directly interferes with the primary tumour and possibly reverses some immunosuppressive barriers within the tumour microenvironment-ideally, recovering the role of the primary tumour as an immunogenic hub. Local radiation also triggers systemic effects that can be used in combination with immunotherapy to induce responses outside the radiation field.

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Conflict of interest statement

Conflicts of interests: The authors declare that they have no competing interests.

Figures

Figure 1
Figure 1
Cytotoxic T lymphocytes (brown) infiltrating residual breast cancer post-radiotherapy
Figure 2
Figure 2
Changes in irradiated tumor (A) promote rejection by effector T cells (B). Tumor antigen-loaded DC migrate to lymph nodes and activate T cells (C) that inhibit metastases (D).
Figure 3
Figure 3
Sagittal (3a) and coronal (3b) views of two metastatic lesions in a case of poorly differentiated thymic carcinoma. Two parallel opposed radiation fields treated the most caudal metastasis, deliberately excluding the apical one.
Figure 4
Figure 4
4a. CT cut of the original apical lesion that was not included in the radiation field (see 3a,b). 4b. The same lesion two months after treatment of a different, caudal metastasis with radiation and GM-CSF.
See this image and copyright information in PMC

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