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Theses

La place de la cryothérapie dans le traitement de la récidive du glioblastome

Abstract : The objective of this thesis is to analyze the place of MRI-guided cryotherapy in the therapeutic strategy for recurrence of glioblastoma. Recurrence of glioblastoma, the most frequent primary malignant tumor in adults, is inevitable with a median survival rate of 8-9 months. Therefore, any new therapeutic modality represents an opportunity to improve survival. Oncologic cryoablation is performed by introducing, under radiological guidance, one or more cryoprobe (s) within a tumor process thus exposing it for a few minutes to extremely low temperatures. In addition, the procedure has been modernized to accurately apply cycles of the freezing and thawing phases. Four biological cellular injury mechanisms are induced and associated in time and space: direct or indirect cellular injury, vascular injury, apoptosis and immunomodulation. By its mechanism, cryotherapy could potentiate the effect of radiotherapy. Thus, a comparison of cryotherapy and radiotherapy treatments alone compared to their combination, on murine brain tumors grafted on immunocompetent mouse models was carried out. The results confirmed the potentiation of cryotherapy over radiotherapy with a significant difference in terms of survival in the radiotherapy combined with cryotherapy group compared to the other groups. The survival of six patients who received MRI-guided cryotherapy followed by microsurgical resection for recurrent glioblastoma was analyzed. We noted the absence of major complications. The overall follow-up was 30 months. The median progression-free survival and overall survival were 7.5 months and 22.5 months, respectively, and the 6-month progression-free survival rate was 50%. Radiological analysis in these 6 patients showed probable rupture of the blood brain barrier within an average of 2.83 months, confirmed by the results of the MRI with injection of gadolinium and by the perfusion sequence. All of this work opens up a new weapon in the management of recurrent glioblastoma by introducing cryotherapy into the existing therapeutic arsenal.
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Submitted on : Friday, July 1, 2022 - 1:26:48 PM
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  • HAL Id : tel-03711398, version 1

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Hélène Cebula. La place de la cryothérapie dans le traitement de la récidive du glioblastome. Médecine humaine et pathologie. Université de Strasbourg, 2021. Français. ⟨NNT : 2021STRAD024⟩. ⟨tel-03711398⟩

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