Proton Craniospinal Irradiation for Leptomeningeal Metastases
Mené sur 98 patients atteints de métastases leptoméningées ayant pour origine un cancer du sein ou du poumon non à petites cellules, cet essai randomisé de phase II évalue l'efficacité, du point de vue de la survie sans progression cérébrale, d'une protonthérapie craniospinale par rapport à une radiothérapie du champ impliqué
Leptomeningeal metastasis (LM) is among the most formidable and devastating challenges in oncology and has long eluded effective treatments. With a historically dismal prognosis, the incidence of LM appears to be increasing due, in part, to an improved lifespan for patients with metastatic cancer and increasingly sophisticated techniques for detecting metastatic spread. An estimated 5% to 10% of patients with metastatic carcinoma will develop LM, particularly from breast, lung, melanoma, or gastrointestinal cancers, as well as those with specific driver variants.The clinical presentation of LM encompasses a constellation of debilitating symptoms that are difficult to manage, even with excellent multidisciplinary and palliative care. Symptoms from LM are often related to nerve injury or increased intracranial pressure due to obstruction of cerebrospinal fluid (CSF) flow or resorption, including intractable headaches, cranial neuropathies, progressive weakness, bowel and bladder dysfunction, and seizure. Treatment approaches for LM are usually palliative, as interventions, such as intrathecal chemotherapy and photon-based craniospinal irradiation (CSI), are associated with substantial toxic effects without meaningful survival benefit to date.
JAMA Oncology , éditorial, 2025