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Impact of radiotherapy administered simultaneously with systemic treatment in patients with melanoma brain metastases within MelBase, a French multicentric prospective cohort

Pauline Tétu 1 Clara Allayous 1 Bastien Oriano 2 Stéphane Dalle 3 Laurent Mortier 4 Marie-Thérèse Leccia 5 Bernard Guillot 6 Sophie Dalac 7 Caroline Dutriaux 8 Jean-Philippe Lacour 9 Philippe Saiag 10 Florence Brunet-Possenti 11 Julie de Quatrebarbes 12 Pierre-Emmanuel Stoebner 13 Delphine Legoupil 14 Marie Beylot-Barry 8 Thierry Lesimple 15 François Aubin 16 Brigitte Dreno 17 Sameh Mohamed 1 Alice Ballon 18 Raphaël Porcher 2 Céleste Lebbé 1 
Abstract : Background: Melanoma brain metastases (MBMs) are historically associated with poor prognosis. Radiation therapy is conventionally associated with a high local control rate. Development of targeted therapy and immunotherapy has improved overall survival (OS) and intracranial response rate, but about 50% of patients failed to respond to these novel therapies. The objective of this study was to assess the impact of combined radiotherapy (cRT) on overall survival in a large multicenter real-life prospective cohort of patients with MBM treated with immunotherapy or targeted therapy.Patients and methods: Clinical data from 262 patients with MBM were collected via MelBase, a French multicentric biobank prospectively enrolling unresectable stage III or IV melanoma. Two groups were defined: patients receiving cRT (cRT group) or not receiving cRT (no-cRT group). Primary end-point was OS. Propensity score weighting was used to correct for indication bias.Results: Among the 262 patients, 93 (35%) received cRT (cRT group). The patients were treated with immunotherapy in 69% and 60% and with targeted therapy in 31% and 40% of the cRT and no-cRT groups, respectively. With a median follow-up of 6.9 months, median OS was 16.8 months and 6.9 months in the cRT and no-cRT groups, respectively. After propensity score weighting, cRT was associated with longer OS (hazard ratio = 0.6, 95% confidence interval: 0.4-0.8; p=0.007). Median OS after ponderation was 15.3 months and 6.2 months in the cRT and no-cRT groups, respectively.Conclusion: This study shows that cRT may be associated with a significant decrease of 40% in the risk of death in patients with MBM treated with systemic therapy.
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Pauline Tétu, Clara Allayous, Bastien Oriano, Stéphane Dalle, Laurent Mortier, et al.. Impact of radiotherapy administered simultaneously with systemic treatment in patients with melanoma brain metastases within MelBase, a French multicentric prospective cohort. European Journal of Cancer, Elsevier, 2019, 112, pp.38-46. ⟨10.1016/j.ejca.2019.02.009⟩. ⟨hal-02872129⟩

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