PMC8009349_01
MRI evolution of brain metastases after fractionated stereotactic brain radiotherapy (A-C) and lorlatinib treatment (D). Three out of the five lesion treated with stereotactic radiotherapy are depicted (B), in the left thalamus (upper panel), left parietal lobe (middle panel) and left lateral ventricle (lower panel). In the upper panel, a contra-lateral sub-centimetric parietal lesion, visible in the first three MRI (A-C), is no more detectable after lorlatinib initiation (D). MRI sequences are 3D MP-RAGE (magnetization prepared - rapid gradient echo) after administration of chelate of gadolinium.
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In November 2019, multiple brain lesions were detected (Figure 1A), without extra-cerebral progression. ECOG performance status (PS) of 2. Entrectinib was suspended and fractionated stereotactic brain radiotherapy was performed on the five largest metastases (the remaining ones being sub-centimetric) (Figure 1B). In January 2020, after entrectinib resumption, new brain MRI and CT scan respectively detected meningeal carcinomatosis (Figure 2A), with partial regression of the irradiated metastases (Figure 1C), and thoracic progression (carcinomatous lymphangitis and parenchymal lesions increase, pleural effusion onset, Figure 3A). CT scan and brain MRI of March 2020, performed six weeks after treatment start, detected thoracic response (Figure 3B), with major regression of brain and meningeal involvement (Figure 1D, Figure 2B).
Major meningeal response to lorlatinib, both at the internal frontal level (upper panel) and in the posterior fossa (lower panel, red arrows). (A) Meningeal progression to entrectinib. (B) Response to lorlatinib after six weeks of treatment.
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In January 2020, after entrectinib resumption, new brain MRI and CT scan respectively detected meningeal carcinomatosis (Figure 2A), with partial regression of the irradiated metastases (Figure 1C), and thoracic progression (carcinomatous lymphangitis and parenchymal lesions increase, pleural effusion onset, Figure 3A). CT scan and brain MRI of March 2020, performed six weeks after treatment start, detected thoracic response (Figure 3B), with major regression of brain and meningeal involvement (Figure 1D, Figure 2B).
Thoracic response to lorlatinib. (A) Progression to entrectinib. (B) Response to lorlatinib after six weeks of treatment.
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In January 2020, after entrectinib resumption, new brain MRI and CT scan respectively detected meningeal carcinomatosis (Figure 2A), with partial regression of the irradiated metastases (Figure 1C), and thoracic progression (carcinomatous lymphangitis and parenchymal lesions increase, pleural effusion onset, Figure 3A). CT scan and brain MRI of March 2020, performed six weeks after treatment start, detected thoracic response (Figure 3B), with major regression of brain and meningeal involvement (Figure 1D, Figure 2B).