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CASEREPORT#2
Amélie Darlix1,CélineGirard2,NicolasMenjot deChampfleur31InstitutrégionalduCancerMontpellierICM,Montpellier,France
2DépartementdeDermatologie,Hôpital SaintEloi,CHUMontpellier,France3DépartementdeNeuroradiologie,Hôpital Gui deChauliac,CHUMontpellier,France
7th Annual Brain Metastases Research andEmerging Therapy ConferenceOctober 6th,2017
76year-oldmaleHistoryofhypertension,cataractandosteoporosis
*February2014:surgicalresectionofamelanomaoftherightscapula,Breslow =2.1mm,Clark=IV,BRAFwild-type,NRASwildtype
Re-intervention(margins=2cm)Noadjuvanttreatment(patient’sage)
CASEREPORT
76year-oldmaleHistoryofhypertension,cataractandosteoporosis
*February2014:surgicalresectionofamelanomaoftherightscapula,Breslow =2.1mm,Clark=IV,BRAFwild-type,NRASwildtype
Re-intervention(margins=2cm)Noadjuvanttreatment(patient’sage)
*June2015:tumorrecurrencewithrightaxillarmetastasis,subcutaneousandlungmetastasesè Pembrolizumab introducedinJuly2015
CASEREPORT
76year-oldmaleHistoryofhypertension,cataractandosteoporosis
*February2014:surgicalresectionofamelanomaoftherightscapula,Breslow =2.1mm,Clark=IV,BRAFwild-type,NRASwildtype
Re-intervention(margins=2cm)Noadjuvanttreatment(patient’sage)
*June2015:tumorrecurrencewithrightaxillarmetastasis,subcutaneousandlungmetastasesè Pembrolizumab introducedinJuly2015
*September2015:systematicbrainMRI
CASEREPORT
CASEREPORT
*February2016:
Subcutaneousmetastasesè DiscontinuationofPembrolizumab after12cyclesandintroductionofIpilimumab (April2016)
CASEREPORT
Sept.2015 Febr.2016
*August2016:discontinuationofIpilimumab (colitis)SystematicbrainMRI
CASEREPORT
CASEREPORT Aug.2016
Whatareyourhypotheses?
A-Multiplecavernomas
B- Cerebralamyloidangiopathy
C-Melanoma-relatedbrainmetastases
D- Ischemiclesions
E- Cysticercosis
QUESTION1
Whatareyourhypotheses?
A- Multiplecavernomas
B- Cerebralamyloidangiopathy
C- Melanoma-relatedbrainmetastases
D- Ischemiclesions
E- Cysticercosis
QUESTION1
CASEREPORT
Shouldthepatientbeconsideredasprogressive?
A- Yes
B- No
QUESTION2
Shouldthepatientbeconsideredasprogressive?
A- Yes
B- No
QUESTION2
Shouldthepatientbeconsideredasprogressive?
A- Yes
B- No
QUESTION2
Wolchok etal.,ClinCancerRes 2009;Okada etal.,LancetOncol 2015
Shouldthepatientbeconsideredasprogressive?
è Significanceoflesion(s)detectedonT2*-weightedsequenceonly?
QUESTION2
Shouldthepatientbeconsideredasprogressive?
è Significanceoflesion(s)detectedonT2*-weightedsequenceonly?
Melanoma-associatedbrainmetastaseshaveaspecificMRIpattern
- Presenceofmelanin- Propensityforbleeding
QUESTION2
T1-weightedhyperintensity55% (vs 12%inlungcancer-associatedmet.)T2*-weightedhypointensity 42%(vs 8%inlungcancer-associatedmet.)
QUESTION2
Significanceoflesion(s)detectedonT2*-weightedsequenceonly?
8/120metastases(7%)wereonlydetectableontheT2*-weightedimagesAllsmalllesions
QUESTION2
Gaviani etal.,AmJneuroradiol 2006
CASEREPORT Aug.2016
*August2016:Extra-cerebraldisease:stableè Nospecificoncologicaltreatment
CASEREPORT
*August2016:Extra-cerebraldisease:stableè Nospecificoncologicaltreatment
*August2017:+subcutaneousandlungmetastases
CASEREPORT
è ShouldT2*-weightedMRIbesystematicallyperformed?AdaptMRIprotocoltotheclinicalcontextè Clinicalbenefitofdetectingandtreatingbrainmetastasesatthe
asymptomaticphase?
CONCLUSION
CASEREPORT#2
Amélie Darlix1,CélineGirard2,NicolasMenjot deChampfleur31InstitutrégionalduCancerMontpellierICM,Montpellier,France
2DépartementdeDermatologie,Hôpital SaintEloi,CHUMontpellier,France3DépartementdeNeuroradiologie,Hôpital Gui deChauliac,CHUMontpellier,France
7th Annual Brain Metastases Research andEmerging Therapy ConferenceOctober 6th,2017
