Immunotherapy and symptomatic radiation necrosis in patients with brain metastases treated with stereotactic radiation
Ce dossier présente deux articles analysant respectivement le risque de pneumonie interstitielle ou de nécrose chez les patients atteints d'un cancer du poumon non à petites cellules, d'un mélanome ou d'un carcinome à cellules rénales et ayant reçu une immunothérapie en combinaison avec un inhibiteur de tyrosine kinase du récepteur EGFR ou une radiothérapie stéréotaxique ciblant des métastases cérébrales
Immunotherapeutic checkpoint inhibitors are commonly used in patients with melanoma, non–small-cell lung cancer (NSCLC), and renal cell carcinoma (RCC), all cancers that frequently metastasize to the brain. Radiation therapy is frequently used for brain metastases because few systemic agents effectively penetrate the blood-brain barrier. The most deleterious consequence of brain-directed, stereotactic radiation is radiation necrosis—inflammation and/or injury to the brain abutting the treated tumor.1 Published literature has suggested that brain-directed stereotactic radiation in patients also receiving immunotherapy may yield beneficial, synergistic effects; however, few studies have examined radiation necrosis. We investigated the association between immunotherapy and symptomatic radiation necrosis in patients with melanoma, NSCLC, or RCC and newly diagnosed brain metastases treated with stereotactic radiation.