Abscopal Effect following Transarterial Radioembolization: A Systematic Review

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Purpose :
The abscopal effect is gaining importance in modern oncology as the link between local irradiation and the immune-mediated systemic anti-tumor effect is becoming more apparent. The study aims to systematically review the literature published on the abscopal effect occurring as a consequence of Transarterial radioembolization.
Materials & Methods :
Using three databases, a systematic review was performed following Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines from the earlier possible date to August 2020. The search strategy was based on the terms “abscopal effect,” “interventional radiotherapy,” “radioembolization,” and “TARE.” The primary outcome of the review was clinical or radiological evidence of the abscopal effect. Additional data collected from each report included the number of patients, study population, IR technique (including isotope used and dose rate), delivered dose, previous use of immunotherapy, primary tumor, and site of intervention.
Results :
Two case reports and one retrospective chart review were included in the analysis. Ninety-eight patients were included across three studies, out of which 3 (3.06%) showed confirmed presence of the abscopal effect. The patient demographics included two females (66.67%), one male (33.33%), the mean age of 55.66 years (median 44 years). The primary tumor was in the breast for two patients (66.67%), and lung for one patient (33.33%). All three patients underwent Transarterial radioembolization (TARE) with Y90 microspheres (SIRspheres), two patients underwent TARE to the right lobe of the liver, and one patient underwent TARE of both the lobes, the median radiation dose was 1.44 GBq. The median time for the abscopal effect was 43 days, and for follow-up was 8 months. The site of the abscopal effect in these cases was extrahepatic metastasis (2/3; 66.67%), and liver metastases (2/3; 66.67%).
Conclusions :
The abscopal effect is a rare phenomenon that was identified in only three immunotherapy naïve cases that underwent radioembolization. The synergy between radiotherapy/ immunotherapy potentially offers a chance to develop new therapies and individualized therapeutic regimens.
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Associated Sessions

Seth GS Medical College
Seth GS Medical College & KEM Hospital

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