Sarah Mezghani

Background: Radiotherapy is an essential component for the treatment of skull skull‑base tumours. However, radiation‑induced brain injury (RIBI) appearing on magnetic resonance imaging (MRI) as pseudoprogression, radiation‑induced contrast enhancement (RICE), radiation necrosis, and other contrast‑enhancing brain lesions—remains an important late toxicity which is not very well characterized. Clarifying adult‑specific patterns, the role of positron emission tomography (PET), and differences between proton and photon therapy is clinically relevant. Methods: Narrative review of peer‑reviewed literature to 1 October 2025 focused on adult chordoma, chondrosarcoma, meningioma, adenoid cystic carcinoma, pituitary adenoma, craniopharyngioma, undifferentiated carcinoma of nasopharyngeal type (UCNT), and germinoma. Results: Radiation-induced brain injury (RIBI) may range from early transient brain oedema/enhancement to late necrosis. Lesions cluster in temporal and frontal lobes after skull‑base irradiation. Proton therapy generally reduces high‑dose exposure versus photons and is associated with fewer severe necrotic events, though asymptomatic RICE is common. Advanced MRI (diffusion, perfusion, spectroscopy, ASL, amide proton transfer) and positron emission tomography (PET) with Fluorodeoxyglucose (FDG) and amino‑acid tracers aid distinction between treatment effect and progression. Risk reflects dose–volume metrics, prior irradiation, and patient comorbidities. Conclusions: MRI/PET alterations after skull‑base radiotherapy vary by modality, dose, and tumor context. Integrating multimodal imaging with clinical factors should guide surveillance and management; prospective validation is needed.

Data regarding elderly melanoma patients treated with anti-PD-1 or anti-CTLA-4 antibodies are in favor of tolerability outcomes that are similar to those of younger counterparts. However, there are very few studies focusing on elderly patients receiving nivolumab combined with ipilimumab (NIVO + IPI). Here, we ask what are the current prescribing patterns of NIVO + IPI in the very elderly population and analyze the tolerance profile. This French multicenter retrospective study was conducted on 60 melanoma patients aged 80 years and older treated with NIVO + IPI between January 2011 and June 2022. The mean age at first NIVO + IPI administration was 83.7 years (range: 79.3–93.3 years). Fifty-five patients (92%) were in good general condition and lived at home. Two dosing regimens were used: NIVO 1 mg/kg + IPI 3 mg/kg Q3W (NIVO1 + IPI3) in 27 patients (45%) and NIVO 3 mg/kg + IPI 1 mg/kg Q3W (NIVO3 + IPI1) in 33 patients (55%). NIVO + IPI was a first-line treatment in 39 patients (65%). The global prevalence of immune-related adverse events was 63% (38/60), with 27% (16/60) being of grade 3 or higher. Grade ≥ 3 adverse events were less frequent in patients treated with NIVO3 + IPI1 compared with those treated with NIVO1 + IPI3 (12% versus 44%, p = 0.04). In conclusion, the prescribing patterns of NIVO + IPI in very elderly patients are heterogeneous in terms of the dosing regimen and line of treatment. The safety profile of NIVO + IPI is reassuring; whether or not the low-dose regimen NIVO3 + IPI1 should be preferred over NIVO1 + IPI3 in patients aged 80 years or older remains an open question.