Abscopal regression following radiotherapy for adenocarcinoma

The word “abscopal” was proposed by Mole (1953) to describe radiation effects occurring at a distance from an irradiated volume. Abscopal regression of malignant tumours following localized radiotherapy to patients with widespread disease is a well-recognized though rare phenomenon, but there are few case reports. It has been most commonly described in leukaemia and lymphoma, but there have been occasional reports in other malignancies. There appears to have been only one previous report of abscopal regression of an adenocarcinoma. We describe two patients who showed abscopal regression of metastases following radiotherapy to a primary adenocarcinoma. In one patient, abscopal regression of lung metastases from a carcinoma in the lower oesophagus lasted approximately 20 months. In the other, regression of metastases from a lung carcinoma was short lived, but associated with a figurate erythema and with obliterative endarteritis at a site of sustained clinical regression. A 49-year-old man presented in September 1974 with adenocarcinoma in the lower oesophagus (Fig. 1). A chest radiograph revealed the classical appearance of multiple lung metastases (Fig. 2). Palliative radiotherapy was given for dysphagia, with an 8-Mev linear accelerator, using a 3-field technique. The minimum dose to the tumour volume was 4000 cGy (rad), in 20 treatments over 28 days, completed in mid-October. The length of the radiation volume was 9 cm and therefore many of the lung metastases were well above the radiation beams.