Étude rétrospective de l'efficacité et de la tolérance de l'association immunothérapie et radiothérapie stéréotaxique cérébrale chez des patients atteints de mélanome métastatique cérébral : analyse des facteurs associés cliniques, radiologiques et histologiques

Abstract : Immunotherapy (IT) made the proof of its efficiency in metastatic melanoma. The association of IT and cerebral stereotactic radiotherapy (SRT) may have both a cerebral and extra-cerebral control. The aim of our study was to estimate the efficiency of the association of IT and cerebral SRT in metastatic melanoma. We conducted a single-center restrospective study of patients with cerebral and extra-cerebral metastatic melanoma, wild BRAF, treated with concurrent IT anti CTLA-4 or anti PD-1 and cerebral SRT from 2013 to 2017. Tumor response was determined using the RECIST v1.1.criteria. We included 14 patients with a total of 44 irradiated cerebral targets lesions and 22 evaluated extra-cerebral targets lesions. Extra-cerebral progression after SRT was 5,1 months (interquartile range 2,9-18,6 months). Overall survival was 24,6 months. Extra-cerebral progress after cerebral SRT seemed to be better in patients with local response to SRT (8,5 months versus 3,8 months, p=0,17). It seemed also to be better with 4 or more irradiated cerebral metastases and did not seem to be different according to DS-GPA score, irradiated maximal tumor volume, PD-L1 expression and neurological symptoms. However this results are not statistically significant given to the small cohort. We observed five grade 3 and 4 toxicity, one radiation necrosis and one cerebral hemorrhage. We repport extra-cerebral data after cerebral SRT in BRAF sauvage metastatic melanoma treated with concurent immunotherapy and cerebral SRT and suggest a better extra-cerebral answer in patients with local response to SRT. Prospective studies are warranted to validate these results.
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Master Thesis
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Laure Cesaire. Étude rétrospective de l'efficacité et de la tolérance de l'association immunothérapie et radiothérapie stéréotaxique cérébrale chez des patients atteints de mélanome métastatique cérébral : analyse des facteurs associés cliniques, radiologiques et histologiques. Médecine humaine et pathologie. 2018. ⟨dumas-02101251⟩

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