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Piper K, Kumar JI, Domino J, Tuchek C, Vogelbaum MA. Consensus review on strategies to improve delivery across the blood-brain barrier including focused ultrasound. Neuro Oncol 2024; 26:1545-1556. [PMID: 38770775 PMCID: PMC11376463 DOI: 10.1093/neuonc/noae087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Indexed: 05/22/2024] Open
Abstract
Drug delivery to the central nervous system (CNS) has been a major challenge for CNS tumors due to the impermeability of the blood-brain barrier (BBB). There has been a multitude of techniques aimed at overcoming the BBB obstacle aimed at utilizing natural transport mechanisms or bypassing the BBB which we review here. Another approach that has generated recent interest in the recently published literature is to use new technologies (Laser Interstitial Thermal Therapy, LITT; or Low-Intensity Focused Ultrasound, LIFU) to temporarily increase BBB permeability. This review overviews the advantages, disadvantages, and major advances of each method. LIFU has been a major area of research to allow for chemotherapeutics to cross the BBB which has a particular emphasis in this review. While most of the advances remain in animal studies, there are an increasing number of translational clinical trials that will have results in the next few years.
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Affiliation(s)
- Keaton Piper
- Department of Neurosurgery, University of South Florida, Tampa, Florida, USA
| | - Jay I Kumar
- Department of Neurosurgery, University of South Florida, Tampa, Florida, USA
| | - Joseph Domino
- Department of Neuro-Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Chad Tuchek
- Department of Neuro-Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Michael A Vogelbaum
- Department of Neuro-Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
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Dabecco R, Gigliotti MJ, Mao G, Myers D, Xu L, Lee P, Ranjan T, Aziz K, Yu A. Laser interstitial thermal therapy (LITT) for intracranial lesions: a single-institutional series, outcomes, and review of the literature. Br J Neurosurg 2024; 38:632-638. [PMID: 34240676 DOI: 10.1080/02688697.2021.1947972] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 06/15/2021] [Accepted: 06/22/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Laser interstitial thermal therapy (LITT) is a minimally invasive treatment method in managing primary brain neoplasms, brain metastases, radiation necrosis, and epileptogenic lesions, many of which are located in operative corridors that would be difficult to address. Although the use of lasers is not a new concept in neurosurgery, advances in technology have enabled surgeons to perform laser treatment with the aid of real-time MRI thermography as a guide. In this report, we present our institutional series and outcomes of patients treated with LITT. METHODS We retrospectively evaluated 19 patients (age range, 28-77 years) who underwent LITT at one or more targets from 2015 to 2019. Primary endpoint observed was mean progression free survival (PFS) and overall survival (OS). RESULTS Seven patients with glial neoplasms and 12 patients with metastatic disease were reviewed. Average hospitalization was 2.4 days. Median PFS was 7 and 4 months in the metastatic group and primary glial neoplasm group, respectively (p = 0.01). Median OS from time of diagnosis was 41 and 32 months (p = 0.02) and median OS after LITT therapy was 25 and 24 months (p = 0.02) for the metastatic and primary glial neoplasm groups, respectively. One patient experienced immediate post-procedural morbidity secondary to increased intracerebral edema peri-lesionally while one patient experienced post-operative mortality and expired secondary to hemorrhage 1-month post-procedure. Median follow-up was 10 months. CONCLUSION Laser interstitial thermal therapy (LITT) is a safe, minimally invasive treatment method that provides surgeons with cytoreductive techniques to treat neurosurgical conditions. Both PFS and OS appear to be more favorable after LITT in patients with metastatic disease. In properly selected patients, this modality offers improved survival outcomes in conjunction with other salvage therapies.
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Affiliation(s)
- Rocco Dabecco
- Department of Neurosurgery, Allegheny General Hospital, Pittsburgh, PA, USA
| | - Michael J Gigliotti
- Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Gordon Mao
- Department of Neurosurgery, Allegheny General Hospital, Pittsburgh, PA, USA
| | - Daniel Myers
- Department of Neurosurgery, Allegheny General Hospital, Pittsburgh, PA, USA
| | - Linda Xu
- Department of Neurosurgery, Allegheny General Hospital, Pittsburgh, PA, USA
| | - Philip Lee
- Department of Neurosurgery, Allegheny General Hospital, Pittsburgh, PA, USA
| | - Tulika Ranjan
- Department of Radiology, Allegheny General Hospital, Pittsburgh, PA, USA
| | - Khaled Aziz
- Department of Neurosurgery, Allegheny General Hospital, Pittsburgh, PA, USA
| | - Alexander Yu
- Department of Neurosurgery, Allegheny General Hospital, Pittsburgh, PA, USA
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Wu H, Zhou F, Gao W, Chen P, Wei Y, Wang F, Zhao H. Current status and research progress of minimally invasive treatment of glioma. Front Oncol 2024; 14:1383958. [PMID: 38835394 PMCID: PMC11148461 DOI: 10.3389/fonc.2024.1383958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 05/07/2024] [Indexed: 06/06/2024] Open
Abstract
Glioma has a high malignant degree and poor prognosis, which seriously affects the prognosis of patients. Traditional treatment methods mainly include craniotomy tumor resection, postoperative radiotherapy and chemotherapy. Although above methods have achieved remarkable curative effect, they still have certain limitations and adverse reactions. With the introduction of the concept of minimally invasive surgery and its clinical application as well as the development and progress of imaging technology, minimally invasive treatment of glioma has become a research hotspot in the field of neuromedicine, including photothermal treatment, photodynamic therapy, laser-induced thermal theraphy and TT-Fields of tumor. These therapeutic methods possess the advantages of precision, minimally invasive, quick recovery and significant curative effect, and have been widely used in clinical practice. The purpose of this review is to introduce the progress of minimally invasive treatment of glioma in recent years and the achievements and prospects for the future.
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Affiliation(s)
- Hao Wu
- Department of Neurosurgery, The Second Affiliated Hospital of Xi'an Medical University, Xi'an, China
| | - Feng Zhou
- Department of Neurosurgery, The First Hospital of Yu Lin, Yulin, China
| | - Wenwen Gao
- Department of Neurosurgery, The Second Affiliated Hospital of Xi'an Medical University, Xi'an, China
| | - Peng Chen
- Department of Neurosurgery, The Second Affiliated Hospital of Xi'an Medical University, Xi'an, China
| | - Yao Wei
- Department of Neurosurgery, The Second Affiliated Hospital of Xi'an Medical University, Xi'an, China
| | - Fenglu Wang
- Department of Neurosurgery, The Second Affiliated Hospital of Xi'an Medical University, Xi'an, China
| | - Haikang Zhao
- Department of Neurosurgery, The Second Affiliated Hospital of Xi'an Medical University, Xi'an, China
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Strauss I, Gabay S, Roth J. Laser interstitial thermal therapy (LITT) for pediatric low-grade glioma-case presentations and lessons learned. Childs Nerv Syst 2024:10.1007/s00381-024-06419-3. [PMID: 38703238 DOI: 10.1007/s00381-024-06419-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Accepted: 04/16/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND The surgical treatment of brain tumors has developed over time, offering customized strategies for patients and their specific lesions. One of the most recent advances in pediatric neuro-oncological surgery is laser interstitial thermal therapy (LITT). However, its effectiveness and indications are still being evaluated. The aim of this work is to review the current literature on LITT for pediatric low-grade gliomas (pLGG) and evaluate our initial results in this context. METHODS We retrospectively reviewed our pediatric neurosurgery database for patients who received LITT treatment between November 2019 and December 2023. We collected data on the indications for LITT, technical issues during the procedure, and clinical and radiological follow-up. RESULTS Three patients underwent 5 LITT procedures for pLGG. The lesion was thalamo-peduncular in one patient, cingulate in one, and deep parietal in one patient. Two patients had a previous open resection done and were diagnosed with pLGG. One patient underwent a stereotaxic biopsy during the LITT procedure that was non-diagnostic. The same patient underwent a later open resection of the tumor in the cingulate gyrus. There were no surgical complications and all patients were discharged home on the first post-operative day. The follow-up period was between 20 and 40 months. Radiological follow-up showed a progressive reduction of the tumor in patients with LGG. CONCLUSION Laser interstitial thermal therapy is a minimally invasive treatment that shows promise in treating deep-seated pLGG in children. The treatment has demonstrated a reduction in tumor volume, and the positive results continue over time. LITT can be used as an alternative treatment for tumors located in areas that are difficult to access surgically or in cases where other standard treatment options have failed.
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Affiliation(s)
- Ido Strauss
- Department of Neurosurgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Segev Gabay
- Department of Neurosurgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Jonathan Roth
- Pediatric Neurosurgery and Pediatric Brain Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Zhao X, Li R, Guo Y, Wan H, Zhou D. Laser interstitial thermal therapy for recurrent glioblastomas: a systematic review and meta-analysis. Neurosurg Rev 2024; 47:159. [PMID: 38625588 DOI: 10.1007/s10143-024-02409-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 01/29/2024] [Accepted: 04/09/2024] [Indexed: 04/17/2024]
Abstract
We aim to investigate the efficacy and safety of laser interstitial thermal therapy (LITT) in treating recurrent glioblastomas (rGBMs). A comprehensive search was conducted in four databases to identify studies published between January 2001 and June 2022 that reported prognosis information of rGBM patients treated with LITT as the primary therapy. The primary outcomes of interest were progression-free survival (PFS) and overall survival (OS) at 6 and 12 months after LITT intervention. Adverse events and complications were also evaluated. Eight eligible non-comparative studies comprising 128 patients were included in the analysis. Seven studies involving 120 patients provided data for the analysis of PFS. The pooled PFS rate at 6 months after LITT was 25% (95% CI 15-37%, I2 = 53%), and at 12 months, it was 9% (95% CI 4-15%, I2 = 24%). OS analysis was performed on 54 patients from six studies, with an OS rate of 92% (95% CI 84-100%, I2 = 0%) at 6 months and 42% (95% CI 13-73%, I2 = 67%) at 12 months after LITT. LITT demonstrates a favorable safety profile with low complication rates and promising tumor control and overall survival rates in patients with rGBMs. Tumor volume and performance status are important factors that may influence the effectiveness of LITT in selected patients. Additionally, the combination of LITT with immune-based therapy holds promise. Further well-designed clinical trials are needed to expand the application of LITT in glioma treatment.
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Affiliation(s)
- Xuzhe Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, #119 Fanyang Road, Fengtai District, Beijing, 100070, China
| | - Runting Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, #119 Fanyang Road, Fengtai District, Beijing, 100070, China
| | - Yiding Guo
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, #119 Fanyang Road, Fengtai District, Beijing, 100070, China
| | - Haibin Wan
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, #119 Fanyang Road, Fengtai District, Beijing, 100070, China
| | - Dabiao Zhou
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, #119 Fanyang Road, Fengtai District, Beijing, 100070, China.
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Jubran JH, Scherschinski L, Dholaria N, Shaftel KA, Farhadi DS, Oladokun FC, Hendricks BK, Smith KA. Magnetic Resonance-Guided Laser Interstitial Thermal Therapy for Recurrent Glioblastoma and Radiation Necrosis: A Single-Surgeon Case Series. World Neurosurg 2024; 182:e453-e462. [PMID: 38036173 DOI: 10.1016/j.wneu.2023.11.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 11/24/2023] [Indexed: 12/02/2023]
Abstract
OBJECTIVE To evaluate long-term clinical outcomes among patients treated with laser interstitial thermal therapy (LITT) for predicted recurrent glioblastoma (rGBM). METHODS Patients with rGBM treated by LITT by a single surgeon (2013-2020) were evaluated for progression-free survival (PFS), overall survival (OS), and OS after LITT. RESULTS Forty-nine patients (33 men, 16 women; mean [SD] age at diagnosis, 58.7 [12.5] years) were evaluated. Among patients with genetic data, 6 of 34 (18%) had IDH-1 R132 mutations, and 7 of 21 (33%) had MGMT methylation. Patients underwent LITT at a mean (SD) of 23.8 (23.8) months after original diagnosis. Twenty of 49 (40%) had previously undergone stereotactic radiosurgery, 37 (75%) had undergone intensity-modulated radiation therapy, and 49 (100%) had undergone chemotherapy. Patients had undergone a mean of 1.2 (0.7) previous resections before LITT. Mean preoperative enhancing and T2 FLAIR volumes were 13.1 (12.8) cm3 and 35.0 (32.8) cm3, respectively. Intraoperative biopsies confirmed rGBM in 31 patients (63%) and radiation necrosis in 18 patients (37%). Six perioperative complications occurred: 3 (6%) cases of worsening aphasia, 1 (2%) seizure, 1 (2%) epidural hematoma, and 1 (2%) intraparenchymal hemorrhage. For the rGBM group, median PFS was 2.0 (IQR, 4.0) months, median OS was 20.0 (IQR, 29.5) months, and median OS after LITT was 6.0 (IQR, 10.5) months. For the radiation necrosis group, median PFS was 4.0 (IQR, 4.5) months, median OS was 37.0 (IQR, 58.0) months, and median OS after LITT was 8.0 (IQR, 23.5) months. CONCLUSIONS In a diverse rGBM cohort, LITT was associated with a short duration of posttreatment PFS.
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Affiliation(s)
- Jubran H Jubran
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Lea Scherschinski
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Nikhil Dholaria
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Kelly A Shaftel
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Dara S Farhadi
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Femi C Oladokun
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Benjamin K Hendricks
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Kris A Smith
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
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Yu P, Yang Y. Meta-analysis of the impact of laser interstitial hyperthermia on wound healing complications in brain tumors. Int Wound J 2024; 21:e14628. [PMID: 38272817 PMCID: PMC10789519 DOI: 10.1111/iwj.14628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 12/13/2023] [Accepted: 12/14/2023] [Indexed: 01/27/2024] Open
Abstract
High-grade gliomas (HGGs) may be amenable to the neurosurgical technique known as laser interstitial thermal therapy (LITT), which delivers thermal energy to interstitial brain injuries and wounds with pinpoint accuracy. The purpose of this extensive meta-analysis was to evaluate the effects of LITT on wound complications among patients who have brain tumours. Diverse conclusions emerge from a systematic review of pertinent studies, necessitating a comprehensive examination. The meta-analysis, performed utilizing the meta library provided by the R package meta, reveals an initial significant overall effect (RR: -2.1262, 95% CI [-2.7466, -1.5059], p < 0.0001) accompanied by considerable heterogeneity among studies (I2 = 61.13%). Following analyses that specifically examined the incidence of wounds, a complex correlation was found (RR: 0.0471, 95% CI [0.0264, 0.0842], p < 0.0001), indicating that LITT has a discernible but insignificant effect on the occurrence of wounds. Although the meta-analysis emphasizes a notable decrease in wound complications subsequent to LITT treatment, additional research is warranted due to constraints in standardized reporting, data accessibility, and small sample sizes. The results of this study underscore the need for exhaustive protocols to analyse wound complications in patients with brain tumours undergoing LITT.
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Affiliation(s)
- Pinrui Yu
- BiologyUniversity of TorontoTorontoOntarioCanada
| | - Yiran Yang
- Global HealthUniversity of TorontoTorontoOntarioCanada
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8
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Brandel MG, Kunwar N, Alattar AA, Kang KM, Forseth KJ, Rennert RC, Shih JJ, Ben-Haim S. A cost analysis of MR-guided laser interstitial thermal therapy for adult refractory epilepsy. Epilepsia 2023; 64:2286-2296. [PMID: 37350343 DOI: 10.1111/epi.17693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 06/12/2023] [Accepted: 06/20/2023] [Indexed: 06/24/2023]
Abstract
OBJECTIVE MR-guided laser interstitial thermal therapy (LITT) is used increasingly for refractory epilepsy. The goal of this investigation is to directly compare cost and short-term adverse outcomes for adult refractory epilepsy treated with temporal lobectomy and LITT, as well as to identify risk factors for increased costs and adverse outcomes. METHODS The National Inpatient Sample (NIS) was queried for patients who received LITT between 2012 and 2019. Patients with adult refractory epilepsy were identified. Multivariable mixed-effects models were used to analyze predictors of cost, length of stay (LOS), and complications. RESULTS LITT was associated with reduced LOS and overall cost relative to temporal lobectomy, with a statistical trend toward lower incidence of postoperative complications. High-volume surgical epilepsy centers had lower LOS overall. Longer LOS was a significant driver of increased cost for LITT, and higher comorbidity was associated with non-routine discharge. SIGNIFICANCE LITT is an affordable alternative to temporal lobectomy for adult refractory epilepsy with an insignificant reduction in inpatient complications. Patients may benefit from expanded access to this treatment modality for both its reduced LOS and lower cost.
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Affiliation(s)
- Michael G Brandel
- Department of Neurosurgery, University of California San Diego, San Diego, California, USA
| | - Nikhita Kunwar
- Department of Neurosurgery, University of California San Diego, San Diego, California, USA
| | - Ali A Alattar
- Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Keiko M Kang
- Department of Neurosurgery, University of Southern California, Los Angeles, California, USA
| | - Kiefer J Forseth
- Department of Neurosurgery, University of California San Diego, San Diego, California, USA
| | - Robert C Rennert
- Department of Neurosurgery, University of Utah, Salt Lake City, Utah, USA
| | - Jerry J Shih
- Department of Neurosciences, University of California San Diego, San Diego, California, USA
| | - Sharona Ben-Haim
- Department of Neurosurgery, University of California San Diego, San Diego, California, USA
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Patel PD, Patel NV, Danish SF. The Evolution of Laser-Induced Thermal Therapy for the Treatment of Gliomas. Neurosurg Clin N Am 2023; 34:199-207. [PMID: 36906327 DOI: 10.1016/j.nec.2022.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
Laser-induced thermal therapy (LITT) has evolved over the past two decades to treat a number of intracranial pathologies. Although it initially emerged as a salvage treatment of surgically inoperable tumors or recurrent lesions that had exhausted more conventional treatments, it is now being used as a primary, first-line treatment in certain instances with outcomes comparable to traditional surgical resection. The authors discuss the evolution of LITT in the treatment of gliomas and future directions, which may further enhance the efficacy of this procedure.
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Affiliation(s)
- Purvee D Patel
- Department of Neurosurgery, Hackensack Meridian School of Medicine, Hackensack Meridian Health - Jersey Shore University Medical Center, Nutley, NJ 07110, USA; Department of Neurosurgery, Hackensack Meridian School of Medicine, Hackensack Meridian Health, Jersey Shore University Hospital, Jersey Shore University Medical Center, 19 Davis Avenue, Hope Tower 4th Floor, Neptune, NJ 07753, USA
| | - Nitesh V Patel
- Department of Neurosurgery, Hackensack Meridian School of Medicine, Hackensack Meridian Health - Jersey Shore University Medical Center, Nutley, NJ 07110, USA; Department of Neurosurgery, Hackensack Meridian School of Medicine, Hackensack Meridian Health, Jersey Shore University Hospital, Jersey Shore University Medical Center, 19 Davis Avenue, Hope Tower 4th Floor, Neptune, NJ 07753, USA
| | - Shabbar F Danish
- Department of Neurosurgery, Hackensack Meridian School of Medicine, Hackensack Meridian Health - Jersey Shore University Medical Center, Nutley, NJ 07110, USA; Department of Neurosurgery, Hackensack Meridian School of Medicine, Hackensack Meridian Health, Jersey Shore University Hospital, Jersey Shore University Medical Center, 19 Davis Avenue, Hope Tower 4th Floor, Neptune, NJ 07753, USA.
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Lawrence JD, Marsh R. Feasibility and Morbidity for the Use of MR-Guided Laser-Induced Thermotherapy for the Treatment of Skull Base Tumors: A Report of Three Cases. J Neurol Surg Rep 2023; 84:e46-e50. [PMID: 37090943 PMCID: PMC10121370 DOI: 10.1055/a-2061-3075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 12/23/2022] [Indexed: 04/25/2023] Open
Abstract
Background Laser-induced thermotherapy (LITT) is a minimally invasive technique that has been demonstrated as an effective treatment of many pathologies; however, it has never been investigated for the use in skull base tumors. Case Series Three patients underwent LITT for treatment of skull base meningiomas. All three patients were determined to be poor candidates for open resection. Each patient was treated with a single laser fiber. Postoperative imaging confirmed ablation zones along the tract of the catheter in all three patients. Ablation zones were estimated to be 9 to 20% of the intended to treat tumor volume. Two of three treated patients suffered cranial nerve injury following the procedure with one patient diagnosed with neurotrophic keratitis and one patient with symptoms consistent with anesthesia dolorosa. Conclusion LITT is a technically feasible, minimally invasive treatment modality for skull base lesions. Significant risk to cranial nerves and small ablation zones afforded by a single cannula placement proposes serious obstacles. Further investigation is warranted prior to using this technique outside of a palliative indication.
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Affiliation(s)
- Jesse D. Lawrence
- Department of Neurosurgery, West Virginia University, Morgantown, West Virginia, United States
- Address for correspondence Jesse D. Lawrence, MD Department of Neurosurgery, West Virginia University, 1 Medical Center DriveMorgantown, WV 26505United States
| | - Robert Marsh
- Department of Neurosurgery, West Virginia University, Morgantown, West Virginia, United States
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Bartlett S, Nagaraja TN, Griffith B, Farmer KG, Van Harn M, Haider S, Hunt RJ, Cabral G, Knight RA, Valadie OG, Brown SL, Ewing JR, Lee IY. Persistent Peri-Ablation Blood-Brain Barrier Opening After Laser Interstitial Thermal Therapy for Brain Tumors. Cureus 2023; 15:e37397. [PMID: 37182017 PMCID: PMC10171839 DOI: 10.7759/cureus.37397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2023] [Indexed: 05/16/2023] Open
Abstract
Purpose Laser interstitial thermal therapy (LITT) is a minimally invasive, image-guided, cytoreductive procedure to treat recurrent glioblastoma. This study implemented dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) methods and employed a model selection paradigm to localize and quantify post-LITT blood-brain barrier (BBB) permeability in the ablation vicinity. Serum levels of neuron-specific enolase (NSE), a peripheral marker of increased BBB permeability, were measured. Methods Seventeen patients were enrolled in the study. Using an enzyme-linked immunosorbent assay, serum NSE was measured preoperatively, 24 hours postoperatively, and at two, eight, 12, and 16 weeks postoperatively, depending on postoperative adjuvant treatment. Of the 17 patients, four had longitudinal DCE-MRI data available, from which blood-to-brain forward volumetric transfer constant (Ktrans) data were assessed. Imaging was performed preoperatively, 24 hours postoperatively, and between two and eight weeks postoperatively. Results Serum NSE increased at 24 hours following ablation (p=0.04), peaked at two weeks, and returned to baseline by eight weeks postoperatively. Ktrans was found to be elevated in the peri-ablation periphery 24 hours after the procedure. This increase persisted for two weeks. Conclusion Following the LITT procedure, serum NSE levels and peri-ablation Ktrans estimated from DCE-MRI demonstrated increases during the first two weeks after ablation, suggesting transiently increased BBB permeability.
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Affiliation(s)
- Seamus Bartlett
- Neurosurgery, Wayne State University School of Medicine, Detroit, USA
| | | | | | | | | | - Sameah Haider
- Neurological Surgery, Henry Ford Health, Detroit, USA
| | | | | | | | | | | | | | - Ian Y Lee
- Neurosurgery, Henry Ford Health, Detroit, USA
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12
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Alkazemi M, Lo YT, Hussein H, Mammi M, Saleh S, Araujo-Lama L, Mommsen S, Pisano A, Lamba N, Bunevicius A, Mekary RA. Laser Interstitial Thermal Therapy for the Treatment of Primary and Metastatic Brain Tumors: A Systematic Review and Meta-Analysis. World Neurosurg 2023; 171:e654-e671. [PMID: 36549438 DOI: 10.1016/j.wneu.2022.12.079] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 12/15/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Laser interstitial thermal therapy (LITT) is a minimally invasive treatment option for intracranial tumors that are challenging to treat via traditional methods; however, its safety and efficacy are not yet well validated in the literature. The objectives of the study were to assess the available evidence of the indications and adverse events (AEs) of LITT and 1-year progression-free survival and 1-year overall survival in the treatment of primary and secondary brain tumors. METHODS A comprehensive literature search was conducted through the databases PubMed, Embase, and the Cochrane Library until October 2021. Comparative and descriptive studies, except for case reports, were included in the meta-analysis. Separate analyses by tumor type (high-grade gliomas, including World Health Organization grade 4 astrocytomas [which include glioblastomas] as a specific subgroup; low-grade gliomas; and brain metastases) were conducted. Pooled effect sizes and their 95% confidence intervals (CI) were generated via random-effects models. RESULTS Forty-five studies met the inclusion criteria, yielding 826 patients for meta-analysis. There were 829 lesions in total, of which 361 were classified as high-grade gliomas, 116 as low-grade gliomas, 337 as metastatic brain tumors, and 15 as nonglial tumors. Indications for offering LITT included deep/inaccessible tumor (12 studies), salvage therapy after failed radiosurgery (9), failures of ≥2 treatment options (3), in pediatric patients (4), patient preference (1); indications were nonspecific in 12 studies. Pooled incidence of all (minor or major) procedure-related AEs was 30% (95% CI, 27%-40%) for all tumors. Pooled incidence of neurologic deficits (minor or major) was 16% (12%-22%); postprocedural edema 14% (8%-22%); seizure 6% (4%-9%); hematoma 20% (14%-29%); deep vein thrombosis 19% (11%-30%); hydrocephalus 8% (5%-12%); and wound infection 5% (3%-7%). One-year progression-free survival was 18.6% (11.3%-29.0%) in high-grade gliomas, 16.9% (11.6%-24.0%) among the grade 4 astrocytomas; and 51.2% (36.7%-65.5%) in brain metastases. One-year overall survival was 43.0% (36.0%-50.0%) in high-grade glioma, 45.9% (95% CI, 37.9%-54%) in grade 4 astrocytomas; 93.0% (42.3%-100%) in low-grade gliomas, and 56.3% (47.0%-65.3%) in brain metastases. CONCLUSIONS New neurologic deficits and postprocedural edema were the most reported AEs after LITT, albeit mostly transient. This meta-analysis provides the best statistical estimates of progression and survival outcomes based on the available information. LITT is generally a safe procedure for selected patients, and future well-designed comparative studies on its outcomes versus the current standard of care should be performed.
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Affiliation(s)
- Maha Alkazemi
- Department of Pharmaceutical Business and Administrative Sciences, School of Pharmacy, MCPHS, Boston, Massachusetts, USA
| | - Yu Tung Lo
- Department of Neurosurgery, Computational Neuroscience Outcomes Center (CNOC), Brigham and Women's Hospital, Boston, Massachusetts, USA; Department of Neurosurgery, National Neuroscience Institute, Singapore, Singapore
| | - Helweh Hussein
- Department of Neurosurgery, Computational Neuroscience Outcomes Center (CNOC), Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Marco Mammi
- Neurosurgery Unit, Santa Croce e Carle Hospital, Cuneo, Italy
| | - Serag Saleh
- Faculty of Medicine, University of Sydney, Sydney, Australia
| | - Lita Araujo-Lama
- Department of Pharmaceutical Business and Administrative Sciences, School of Pharmacy, MCPHS, Boston, Massachusetts, USA
| | - Shannon Mommsen
- Department of Pharmaceutical Business and Administrative Sciences, School of Pharmacy, MCPHS, Boston, Massachusetts, USA
| | - Alessandra Pisano
- Department of Pharmaceutical Business and Administrative Sciences, School of Pharmacy, MCPHS, Boston, Massachusetts, USA
| | - Nayan Lamba
- Department of Neurosurgery, Computational Neuroscience Outcomes Center (CNOC), Brigham and Women's Hospital, Boston, Massachusetts, USA; Department of Radiation Oncology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Adomas Bunevicius
- Department of Neurosurgery, Computational Neuroscience Outcomes Center (CNOC), Brigham and Women's Hospital, Boston, Massachusetts, USA; Neuroscience Institute, Lithuanian University of Health Science, Kaunas, Lithuania; Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA; Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Rania A Mekary
- Department of Pharmaceutical Business and Administrative Sciences, School of Pharmacy, MCPHS, Boston, Massachusetts, USA; Department of Neurosurgery, Computational Neuroscience Outcomes Center (CNOC), Brigham and Women's Hospital, Boston, Massachusetts, USA.
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Fadel HA, Haider S, Pawloski JA, Zakaria HM, Macki M, Bartlett S, Schultz L, Robin AM, Kalkanis SN, Lee IY. Laser Interstitial Thermal Therapy for First-Line Treatment of Surgically Accessible Recurrent Glioblastoma: Outcomes Compared With a Surgical Cohort. Neurosurgery 2022; 91:701-709. [PMID: 35986677 DOI: 10.1227/neu.0000000000002093] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 06/05/2022] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND Laser interstitial thermal therapy (LITT) for glioblastoma (GBM) has been reserved for poor surgical candidates and deep "inoperable" lesions. We present the first reported series of LITT for surgically accessible recurrent GBM (rGBM) that would otherwise be treated with surgical resection. OBJECTIVE To evaluate the use of LITT for unifocal, lobar, first-time rGBM compared with a similar surgical cohort. METHODS A retrospective institutional database was used to identify patients with unifocal, lobar, first-time rGBM who underwent LITT or resection between 2013 and 2020. Clinical and volumetric lesional characteristics were compared between cohorts. Subgroup analysis of patients with lesions ≤20 cm 3 was also completed. Primary outcomes were overall survival and progression-free survival. RESULTS Of the 744 patients with rGBM treated from 2013 to 2020, a LITT cohort of 17 patients were compared with 23 similar surgical patients. There were no differences in baseline characteristics, although lesions were larger in the surgical cohort (7.54 vs 4.37 cm 3 , P = .017). Despite differences in lesion size, both cohorts had similar extents of ablation/resection (90.7% vs 95.1%, P = .739). Overall survival (14.1 vs 13.8 months, P = .578) and progression-free survival (3.7 vs 3.3 months, P = 0. 495) were similar. LITT patients had significantly shorter hospital stays (2.2 vs 3.0 days, P = .004). Subgroup analysis of patients with lesions ≤20 cm 3 showed similar outcomes, with LITT allowing for significantly shorter hospital stays. CONCLUSION We found no difference in survival outcomes or morbidity between LITT and repeat surgery for surgically accessible rGBM while LITT resulted in shorter hospital stays and more efficient postoperative care.
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Affiliation(s)
- Hassan A Fadel
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Sameah Haider
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Jacob A Pawloski
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Hesham M Zakaria
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Mohamed Macki
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Seamus Bartlett
- Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Lonni Schultz
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA
- Department of Public Health Sciences, Henry Ford Hospital, Detroit, Michigan, USA
| | - Adam M Robin
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Steven N Kalkanis
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Ian Y Lee
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA
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Wang L, Shi Y, Jiang J, Li C, Zhang H, Zhang X, Jiang T, Wang L, Wang Y, Feng L. Micro-Nanocarriers Based Drug Delivery Technology for Blood-Brain Barrier Crossing and Brain Tumor Targeting Therapy. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2022; 18:e2203678. [PMID: 36103614 DOI: 10.1002/smll.202203678] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 08/04/2022] [Indexed: 06/15/2023]
Abstract
The greatest obstacle to using drugs to treat brain tumors is the blood-brain barrier (BBB), making it difficult for conventional drug molecules to enter the brain. Therefore, how to safely and effectively penetrate the BBB to achieve targeted drug delivery to brain tumors has been a challenging research problem. With the intensive research in micro- and nanotechnology in recent years, nano drug-targeted delivery technologies have shown great potential to overcome this challenge, such as inorganic nanocarriers, organic polymer-carriers, liposomes, and biobased carriers, which can be designed in different sizes, shapes, and surface functional groups to enhance their ability to penetrate the BBB and targeted drug delivery for brain tumors. In this review, the composition and overcoming patterns of the BBB are detailed, and then the hot research topics of drug delivery carriers for brain tumors in recent years are summarized, and their mechanisms of action on the BBB and the factors affecting drug delivery are described in detail, and the effectiveness of targeted therapy for brain tumors is evaluated. Finally, the challenges and dilemmas in developing brain tumor drug delivery systems are discussed, which will be promising in the future for targeted drug delivery to brain tumors based on micro-nanocarriers technology.
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Affiliation(s)
- Luyao Wang
- School of Mechanical Engineering & Automation, Beihang University, Beijing, 100191, China
| | - Youyuan Shi
- School of Mechanical Engineering & Automation, Beihang University, Beijing, 100191, China
| | - Jingzhen Jiang
- Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China
| | - Chan Li
- School of Mechanical Engineering & Automation, Beihang University, Beijing, 100191, China
| | - Hengrui Zhang
- School of Mechanical Engineering & Automation, Beihang University, Beijing, 100191, China
| | - Xinhui Zhang
- School of Mechanical Engineering & Automation, Beihang University, Beijing, 100191, China
| | - Tao Jiang
- Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050, China
| | - Liang Wang
- Department of Hematology, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Yinyan Wang
- Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050, China
| | - Lin Feng
- School of Mechanical Engineering & Automation, Beihang University, Beijing, 100191, China
- Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, Beijing, 100191, China
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15
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Surgical Treatment of Glioblastoma: State-of-the-Art and Future Trends. J Clin Med 2022; 11:jcm11185354. [PMID: 36143001 PMCID: PMC9505564 DOI: 10.3390/jcm11185354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 08/17/2022] [Accepted: 08/31/2022] [Indexed: 11/22/2022] Open
Abstract
Glioblastoma (GBM) is a highly aggressive disease and is associated with poor prognosis despite treatment advances in recent years. Surgical resection of tumor remains the main therapeutic option when approaching these patients, especially when combined with adjuvant radiochemotherapy. In the present study, we conducted a comprehensive literature review on the state-of-the-art and future trends of the surgical treatment of GBM, emphasizing topics that have been the object of recent study.
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16
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Adaptation of laser interstitial thermal therapy for tumor ablation under MRI monitoring in a rat orthotopic model of glioblastoma. Acta Neurochir (Wien) 2021; 163:3455-3463. [PMID: 34554269 DOI: 10.1007/s00701-021-05002-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 09/01/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Laser interstitial thermal therapy (LITT) under magnetic resonance imaging (MRI) monitoring is being increasingly used in cytoreductive surgery of recurrent brain tumors and tumors located in eloquent brain areas. The objective of this study was to adapt this technique to an animal glioma model. METHODS A rat model of U251 glioblastoma (GBM) was employed. Tumor location and extent were determined by MRI and dynamic contrast-enhanced (DCE) MRI. A day after assessing tumor appearance, tumors were ablated during diffusion-weighted imaging (DWI)-MRI using a Visualase LITT system (n = 5). Brain images were obtained immediately after ablation and again at 24 h post-ablation to confirm the efficacy of tumor cytoablation. Untreated tumors served as controls (n = 3). Rats were injected with fluorescent isothiocyanate (FITC) dextran and Evans blue that circulated for 10 min after post-LITT MRI. The brains were then removed for fluorescence microscopy and histopathology evaluations using hematoxylin and eosin (H&E) and major histocompatibility complex (MHC) staining. RESULTS All rats showed a space-occupying tumor with T2 and T1 contrast-enhancement at pre-LITT imaging. The rats that underwent the LITT procedure showed a well-demarcated ablation zone with near-complete ablation of tumor tissue and with peri-ablation contrast enhancement at 24 h post-ablation. Tumor cytoreduction by ablation as seen on MRI was confirmed by H&E and MHC staining. CONCLUSIONS Data showed that tumor cytoablation using MRI-monitored LITT was possible in preclinical glioma models. Real-time MRI monitoring facilitated visualizing and controlling the area of ablation as it is otherwise performed in clinical applications.
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17
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Malcolm JG, Douglas JM, Greven A, Rich C, Dawoud RA, Hu R, Reisner A, Barrow DL, Gross RE, Willie JT. Feasibility and Morbidity of Magnetic Resonance Imaging-Guided Stereotactic Laser Ablation of Deep Cerebral Cavernous Malformations: A Report of 4 Cases. Neurosurgery 2021; 89:635-644. [PMID: 34270738 DOI: 10.1093/neuros/nyab241] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 05/08/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Magnetic resonance imaging (MRI)-guided laser interstitial thermal therapy (MRgLITT) has been used successfully to treat epileptogenic cortical cerebral cavernous malformations (CCM). It is unclear whether MRgLITT would be as feasible or safe for deep CCMs. OBJECTIVE To describe our experience with MRgLITT for symptomatic deep CCMs. METHODS Patients' records were reviewed retrospectively. MRgLITT was carried out using a commercially available system in an interventional MRI suite with efforts to protect adjacent brain structures. Immediate postoperative imaging was used to judge ablation adequacy. Delayed postoperative MRI was used to measure lesion volume changes during follow-up. RESULTS Four patients with CCM in the thalamus, putamen, midbrain, or subthalamus presented with persistent and disabling neurological symptoms. A total of 2 patients presented with disabling headaches and sensory disturbances and 2 with recurrent symptomatic hemorrhages, of which 1 had familial CCM. Patients were considered by vascular neurosurgeons to be poor candidates for open surgery or had refused it. Multiple trajectories were used in most cases. Adverse events included device malfunction with leakage of saline causing transient mass effect in one patient, and asymptomatic tract hemorrhage in another. One patient suffered an expected mild but persistent exacerbation of baseline deficits. All patients showed improvement from a previously aggressive clinical course with lesion volume decreased by 20% to 73% in follow-up. CONCLUSION MRgLITT is feasible in the treatment of symptomatic deep CCM but may carry a high risk of complications without the benefit of definitive resection. We recommend cautious patient selection, low laser power settings, and conservative temperature monitoring in surrounding brain parenchyma.
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Affiliation(s)
- James G Malcolm
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | | | - Alex Greven
- Emory University School of Medicine, Atlanta, Georgia, USA
| | | | - Reem A Dawoud
- Emory University School of Medicine, Atlanta, Georgia, USA
| | - Ranliang Hu
- Department of Radiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Andrew Reisner
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA.,Department of Neurosurgery, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Daniel L Barrow
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Robert E Gross
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Jon T Willie
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA
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18
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Campwala Z, Szewczyk B, Maietta T, Trowbridge R, Tarasek M, Bhushan C, Fiveland E, Ghoshal G, Heffter T, Gandomi K, Carvalho PA, Nycz C, Jeannotte E, Staudt M, Nalwalk J, Hellman A, Zhao Z, Burdette EC, Fischer G, Yeo D, Pilitsis JG. Predicting ablation zones with multislice volumetric 2-D magnetic resonance thermal imaging. Int J Hyperthermia 2021; 38:907-915. [PMID: 34148489 PMCID: PMC9284994 DOI: 10.1080/02656736.2021.1936215] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND High-intensity focused ultrasound (HIFU) serves as a noninvasive stereotactic system for the ablation of brain metastases; however, treatments are limited to simple geometries and energy delivery is limited by the high acoustic attenuation of the calvarium. Minimally-invasive magnetic resonance-guided robotically-assisted (MRgRA) needle-based therapeutic ultrasound (NBTU) using multislice volumetric 2-D magnetic resonance thermal imaging (MRTI) overcomes these limitations and has potential to produce less collateral tissue damage than current methods. OBJECTIVE To correlate multislice volumetric 2-D MRTI volumes with histologically confirmed regions of tissue damage in MRgRA NBTU. METHODS Seven swine underwent a total of 8 frontal MRgRA NBTU lesions. MRTI ablation volumes were compared to histologic tissue damage on brain sections stained with 2,3,5-triphenyltetrazolium chloride (TTC). Bland-Altman analyses and correlation trends were used to compare MRTI and TTC ablation volumes. RESULTS Data from the initial and third swine's ablations were excluded due to sub-optimal tissue staining. For the remaining ablations (n = 6), the limits of agreement between the MRTI and histologic volumes ranged from -0.149 cm3 to 0.252 cm3 with a mean difference of 0.052 ± 0.042 cm3 (11.1%). There was a high correlation between the MRTI and histology volumes (r2 = 0.831) with a strong linear relationship (r = 0.868). CONCLUSION We used a volumetric MRTI technique to accurately track thermal changes during MRgRA NBTU in preparation for human trials. Improved volumetric coverage with MRTI enhanced our delivery of therapy and has far-reaching implications for focused ultrasound in the broader clinical setting.
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Affiliation(s)
- Zahabiya Campwala
- Department of Neuroscience and Experimental Therapeutics, Albany Medical Center, Albany, NY, USA
| | - Benjamin Szewczyk
- Department of Neurosurgery, Albany Medical Center, Albany, NY, USA.,Robotics Engineering Department, Worcester Polytechnic Institute, Worcester, MA, USA
| | - Teresa Maietta
- Department of Neuroscience and Experimental Therapeutics, Albany Medical Center, Albany, NY, USA
| | - Rachel Trowbridge
- Department of Neuroscience and Experimental Therapeutics, Albany Medical Center, Albany, NY, USA
| | | | | | | | | | | | - Katie Gandomi
- Robotics Engineering Department, Worcester Polytechnic Institute, Worcester, MA, USA
| | | | - Christopher Nycz
- Robotics Engineering Department, Worcester Polytechnic Institute, Worcester, MA, USA
| | - Erin Jeannotte
- Animal Resources Facility, Albany Medical Center, Albany, NY, USA
| | - Michael Staudt
- Department of Neurosurgery, Albany Medical Center, Albany, NY, USA
| | - Julia Nalwalk
- Department of Neuroscience and Experimental Therapeutics, Albany Medical Center, Albany, NY, USA
| | - Abigail Hellman
- Department of Neuroscience and Experimental Therapeutics, Albany Medical Center, Albany, NY, USA
| | - Zhanyue Zhao
- Robotics Engineering Department, Worcester Polytechnic Institute, Worcester, MA, USA
| | | | - Gregory Fischer
- Robotics Engineering Department, Worcester Polytechnic Institute, Worcester, MA, USA
| | - Desmond Yeo
- GE Global Research Center, Niskayuna, NY, USA
| | - Julie G Pilitsis
- Department of Neuroscience and Experimental Therapeutics, Albany Medical Center, Albany, NY, USA.,Department of Neurosurgery, Albany Medical Center, Albany, NY, USA
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19
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Eichberg DG, Menaker SA, Jermakowicz WJ, Shah AH, Luther EM, Jamshidi AM, Semonche AM, Di L, Komotar RJ, Ivan ME. Multiple Iterations of Magnetic Resonance-Guided Laser Interstitial Thermal Ablation of Brain Metastases: Single Surgeon's Experience and Review of the Literature. Oper Neurosurg (Hagerstown) 2021; 19:195-204. [PMID: 31828344 DOI: 10.1093/ons/opz375] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 09/29/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Prior treatment with magnetic resonance-guided, laser-induced thermal therapy (LITT) is widely assumed not to be a contraindication for further treatment of brain lesions, including further iterations of LITT. However, the safety and efficacy of repeat LITT treatments have never been formally investigated. OBJECTIVE To evaluate treatment with multiple iterations of LITT. METHODS All patients treated with LITT at least twice at our institution were included in the study. Outcomes and neurological examinations from before and after surgery were retrospectively examined from clinic notes. Perilesonal edema was determined at various timepoints using volumetric data derived from manual tracings of fluid-attenuated inversion recovery (FLAIR) enhancement on magnetic resonance imaging (MRI). Finally, a literature review of prior cases of repeat LITT was performed. RESULTS A total of 9 patients underwent 18 treatments with LITT; all but 1 of whom were treated for metastatic brain lesions. One patient had a transient cerebrospinal fluid leak, whereas a second patient had a superficial wound infection, both of which resolved with standard medical care. The remaining 7 patients tolerated all LITT procedures without complication. Analysis of perilesional edema volume demonstrated a correlation with the amount of energy delivered during LITT. Literature review found 5 published papers describing 9 patients who underwent LITT more than once, the majority of whom tolerated repeat LITT well. CONCLUSION LITT is a safe and promising treatment modality and may be used multiple times without issue. There appears to be an association between the amount of energy delivered during a LITT session and the degree of postoperative perilesional edema.
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Affiliation(s)
- Daniel G Eichberg
- Department of Neurological Surgery, Miller School of Medicine, University of Miami, Miami, Florida
| | - Simon A Menaker
- Department of Neurological Surgery, Miller School of Medicine, University of Miami, Miami, Florida
| | - Walter J Jermakowicz
- Department of Neurological Surgery, Miller School of Medicine, University of Miami, Miami, Florida
| | - Ashish H Shah
- Department of Neurological Surgery, Miller School of Medicine, University of Miami, Miami, Florida
| | - Evan M Luther
- Department of Neurological Surgery, Miller School of Medicine, University of Miami, Miami, Florida
| | - Aria M Jamshidi
- Department of Neurological Surgery, Miller School of Medicine, University of Miami, Miami, Florida
| | - Alexa M Semonche
- Department of Neurological Surgery, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey
| | - Long Di
- Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Ricardo J Komotar
- Department of Neurological Surgery, Miller School of Medicine, University of Miami, Miami, Florida
| | - Michael E Ivan
- Department of Neurological Surgery, Miller School of Medicine, University of Miami, Miami, Florida
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20
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Shan W, Mao X, Wang X, Hogan RE, Wang Q. Potential surgical therapies for drug-resistant focal epilepsy. CNS Neurosci Ther 2021; 27:994-1011. [PMID: 34101365 PMCID: PMC8339538 DOI: 10.1111/cns.13690] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 05/07/2021] [Accepted: 05/18/2021] [Indexed: 12/19/2022] Open
Abstract
Drug-resistant focal epilepsy (DRFE), defined by failure of two antiepileptic drugs, affects 30% of epileptic patients. Epilepsy surgeries are alternative options for this population. Preoperative evaluation is critical to include potential candidates, and to choose the most appropriate procedure to maximize efficacy and simultaneously minimize side effects. Traditional procedures involve open skull surgeries and epileptic focus resection. Alternatively, neuromodulation surgeries use peripheral nerve or deep brain stimulation to reduce the activities of epileptogenic focus. With the advanced improvement of laser-induced thermal therapy (LITT) technique and its utilization in neurosurgery, magnetic resonance-guided LITT (MRgLITT) emerges as a minimal invasive approach for drug-resistant focal epilepsy. In the present review, we first introduce drug-resistant focal epilepsy and summarize the indications, pros and cons of traditional surgical procedures and neuromodulation procedures. And then, focusing on MRgLITT, we thoroughly discuss its history, its technical details, its safety issues, and current evidence on its clinical applications. A case report on MRgLITT is also included to illustrate the preoperational evaluation. We believe that MRgLITT is a promising approach in selected patients with drug-resistant focal epilepsy, although large prospective studies are required to evaluate its efficacy and side effects, as well as to implement a standardized protocol for its application.
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Affiliation(s)
- Wei Shan
- Department of NeurologyBeijing Tiantan HospitalCapital Medical UniversityBeijingChina
- National Center for Clinical Medicine of Neurological DiseasesBeijingChina
- Beijing Institute for Brain DisordersBeijingChina
- Beijing Key Laboratory of Neuro‐modulationBeijingChina
| | - Xuewei Mao
- Shandong Key Laboratory of Industrial Control TechnologySchool of AutomationQingdao UniversityQingdaoChina
| | - Xiu Wang
- National Center for Clinical Medicine of Neurological DiseasesBeijingChina
| | - Robert E. Hogan
- Departments of Neurology and NeurosurgerySchool of MedicineWashington University in St. LouisSt. LouisMOUSA
| | - Qun Wang
- Department of NeurologyBeijing Tiantan HospitalCapital Medical UniversityBeijingChina
- National Center for Clinical Medicine of Neurological DiseasesBeijingChina
- Beijing Institute for Brain DisordersBeijingChina
- Beijing Key Laboratory of Neuro‐modulationBeijingChina
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21
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Munoz-Casabella A, Alvi MA, Rahman M, Burns TC, Brown DA. Laser Interstitial Thermal Therapy for Recurrent Glioblastoma: Pooled Analyses of Available Literature. World Neurosurg 2021; 153:91-97.e1. [PMID: 34087459 DOI: 10.1016/j.wneu.2021.05.114] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 05/24/2021] [Accepted: 05/25/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVE/BACKGROUND The efficacy of laser interstitial thermal therapy (LITT) in recurrent glioblastoma (rGBM) is unknown. The goal of this study was to conduct a systematic review and pooled analysis of the literature for outcomes on patients with rGBM undergoing LITT. METHODS A literature search was performed to retrieve all studies investigating overall survival, postprocedure survival, and progression-free survival outcomes of patients with rGBM undergoing LITT. Statistics were pooled together by meta-analysis of mean using a weighted random-effects or fixed-effect model. RESULTS Eleven studies were included in the final cohort, representing a total of 134 patients with rGBM. The pooled mean age of the cohort at the time of recurrence was 56.7 ± 4.56 years; 41% of the cohort were female. For delivery of LITT, 2 studies used neodymium-yttrium aluminum-garnet laser (Nd:YAG laser), 3 studies used the Visualase system, 5 studies used the NeuroBlate system, and 1 study used both the NeuroBlate and the Visualase system. A total of 8 studies with 107 patients had available data for overall median survival. The pooled overall survival was found to be 18.6 months (95% confidence interval [CI] 16.2-21.1). A total of 6 studies with 93 patients had available data for post-LITT survival. The pooled post-LITT survival was found to be 10.1 months (95% CI 8.8-11.6). A total of 8 studies with 119 patients had available data for progression-free survival. Pooled progression free survival was found to be 6 months (95% CI 5.3-6.7). CONCLUSIONS LITT is a novel minimally invasive procedure which, when used with optimal adjuvant therapy, may confer survival benefit for patients with rGBM.
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Affiliation(s)
| | - Mohammed Ali Alvi
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Masum Rahman
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Terry C Burns
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Desmond A Brown
- Neurosurgical Oncology Unit, Surgical Neurology Branch, National Institutes of Neurological Disorders and Stroke, NIH, Bethesda, Maryland, USA.
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Avecillas-Chasin JM, Atik A, Mohammadi AM, Barnett GH. Laser thermal therapy in the management of high-grade gliomas. Int J Hyperthermia 2021; 37:44-52. [PMID: 32672121 DOI: 10.1080/02656736.2020.1767807] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Laser interstitial thermal therapy (LITT) is a minimally invasive therapy that have been used for brain tumors, epilepsy, chronic pain, and other spine pathologies. This therapy is performed under imaging and stereotactic guidance to precisely direct the probe and ablate the area of interest using real-time magnetic resonance (MR) thermography. LITT has gained popularity as a treatment for glioma because of its minimally invasive nature, small skin incision, repeatability, shorter hospital stay, and the possibility of receiving adjuvant therapy shortly after surgery instead of several weeks as required after open surgical resection. Several reports have demonstrated the usefulness of LITT in the treatment of newly-diagnosed and recurrent gliomas. In this review, we will summarize the recent evidence of this therapy in the field of glioma surgery and the future perspectives of the use of LITT combined with other treatment strategies for this devastating disease.
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Affiliation(s)
- Josue M Avecillas-Chasin
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, USA.,Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, OH, USA.,Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ahmet Atik
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, USA.,Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, OH, USA.,Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Alireza M Mohammadi
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, USA.,Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, OH, USA.,Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Gene H Barnett
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, USA.,Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, OH, USA.,Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
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23
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Diagnosis and Management of Glioblastoma: A Comprehensive Perspective. J Pers Med 2021; 11:jpm11040258. [PMID: 33915852 PMCID: PMC8065751 DOI: 10.3390/jpm11040258] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 03/24/2021] [Accepted: 03/30/2021] [Indexed: 12/11/2022] Open
Abstract
Glioblastoma is the most common malignant brain tumor in adults. The current management relies on surgical resection and adjuvant radiotherapy and chemotherapy. Despite advances in our understanding of glioblastoma onset, we are still faced with an increased incidence, an altered quality of life and a poor prognosis, its relapse and a median overall survival of 15 months. For the past few years, the understanding of glioblastoma physiopathology has experienced an exponential acceleration and yielded significant insights and new treatments perspectives. In this review, through an original R-based literature analysis, we summarize the clinical presentation, current standards of care and outcomes in patients diagnosed with glioblastoma. We also present the recent advances and perspectives regarding pathophysiological bases as well as new therapeutic approaches such as cancer vaccination and personalized treatments.
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24
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Traylor JI, Patel R, Muir M, de Almeida Bastos DC, Ravikumar V, Kamiya-Matsuoka C, Rao G, Thomas JG, Kew Y, Prabhu SS. Laser Interstitial Thermal Therapy for Glioblastoma: A Single-Center Experience. World Neurosurg 2021; 149:e244-e252. [PMID: 33610872 DOI: 10.1016/j.wneu.2021.02.044] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 02/09/2021] [Accepted: 02/10/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Surgical resection has been shown to prolong survival in patients with glioblastoma multiforme (GBM), although this benefit has not been demonstrated for reoperation following tumor recurrence. Laser interstitial thermal therapy (LITT) is a minimally invasive ablation technique that has been shown to effectively reduce tumor burden in some patients with intracranial malignancy. The aim of this study was to describe the safety and efficacy of LITT for recurrent and newly diagnosed GBM at a large tertiary referral center. METHODS Patients with GBM receiving LITT were retrospectively analyzed. Overall survival from the time of LITT was the primary end point measured. RESULTS There were 69 patients identified for inclusion in this study. The median age of the cohort was 56 years (range, 15-77 years). Median tumor volume was 10.4 cm3 (range, 1.0-64.0 cm3). A Kaplan-Meier estimate of median overall survival for the series from the time of LITT was 12 months (95% confidence interval 8-16 months). Median progression-free survival for the cohort from LITT was 4 months (95% confidence interval 3-7 months). Adjuvant chemotherapy significantly prolonged progression-free survival and overall survival (P < 0.01 for both) in the cohort. Gross total ablation was not significantly associated with progression-free survival (P = 0.09). CONCLUSIONS LITT can safely reduce intracranial tumor burden in patients with GBM who have exhausted other adjuvant therapies or are poor candidates for conventional resection techniques.
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Affiliation(s)
- Jeffrey I Traylor
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Rajan Patel
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Matthew Muir
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | - Visweswaran Ravikumar
- Department of Bioinformatics and Computational Biology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, Michigan, USA
| | - Carlos Kamiya-Matsuoka
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ganesh Rao
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jonathan G Thomas
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Yvonne Kew
- Department of Neurology, Baylor St. Luke's Medical Center, Houston, Texas, USA
| | - Sujit S Prabhu
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
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25
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Chen C, Lee I, Tatsui C, Elder T, Sloan AE. Laser interstitial thermotherapy (LITT) for the treatment of tumors of the brain and spine: a brief review. J Neurooncol 2021; 151:429-442. [PMID: 33611709 PMCID: PMC7897607 DOI: 10.1007/s11060-020-03652-z] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 10/15/2020] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Laser Interstitial Thermotherapy (LITT; also known as Stereotactic Laser Ablation or SLA), is a minimally invasive treatment modality that has recently gained prominence in the treatment of malignant primary and metastatic brain tumors and radiation necrosis and studies for treatment of spinal metastasis has recently been reported. METHODS Here we provide a brief literature review of the various contemporary uses for LITT and their reported outcomes. RESULTS Historically, the primary indication for LITT has been for the treatment of recurrent glioblastoma (GBM). However, indications have continued to expand and now include gliomas of different grades, brain metastasis (BM), radiation necrosis (RN), other types of brain tumors as well as spine metastasis. LITT is emerging as a safe, reliable, minimally invasive clinical approach, particularly for deep seated, focal malignant brain tumors and radiation necrosis. The role of LITT for treatment of other types of tumors of the brain and for spine tumors appears to be evolving at a small number of centers. While the technology appears to be safe and increasingly utilized, there have been few prospective clinical trials and most published studies combine different pathologies in the same report. CONCLUSION Well-designed prospective trials will be required to firmly establish the role of LITT in the treatment of lesions of the brain and spine.
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Affiliation(s)
- Clark Chen
- University of Minnesotta, Minneapolis, USA
| | - Ian Lee
- Henry Ford Hospitals, Detroit, USA
| | | | - Theresa Elder
- Seidman Cancer Center, University Hospitals, Shaker Heights, USA
| | - Andrew E Sloan
- Seidman Cancer Center, University Hospitals, Shaker Heights, USA.
- Case Comprehensive Cancer Center, Cleveland, USA.
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26
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Nagaraja TN, Lee IY. Cerebral microcirculation in glioblastoma: A major determinant of diagnosis, resection, and drug delivery. Microcirculation 2021; 28:e12679. [PMID: 33474805 DOI: 10.1111/micc.12679] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 01/12/2021] [Indexed: 12/25/2022]
Abstract
Glioblastoma (GBM) is the most common primary brain tumor with a dismal prognosis. Current standard of treatment is safe maximal tumor resection followed by chemotherapy and radiation. Altered cerebral microcirculation and elevated blood-tumor barrier (BTB) permeability in tumor periphery due to glioma-induced vascular dysregulation allow T1 contrast-enhanced visualization of resectable tumor boundaries. Newer tracers that label the tumor and its vasculature are being increasingly used for intraoperative delineation of glioma boundaries for even more precise resection. Fluorescent 5-aminolevulinic acid (5-ALA) and indocyanine green (ICG) are examples of such intraoperative tracers. Recently, magnetic resonance imaging (MRI)-based MR thermometry is being employed for laser interstitial thermal therapy (LITT) for glioma debulking. However, aggressive, fatal recurrence always occurs. Postsurgical chemotherapy is hampered by the inability of most drugs to cross the blood-brain barrier (BBB). Understanding postsurgical changes in brain microcirculation and permeability is crucial to improve chemotherapy delivery. It is important to understand whether any microcirculatory indices can differentiate between true recurrence and radiation necrosis. LITT leads to peri-ablation BBB opening that persists for several weeks. Whether it can be a conduit for chemotherapy delivery is yet to be explored. This review will address the role of cerebral microcirculation in such emerging ideas in GBM diagnosis and therapy.
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Affiliation(s)
| | - Ian Y Lee
- Department of Neurosurgery, Henry Ford Hospital, Detroit, MI, USA
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27
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Mirza FA, Mitha R, Shamim MS. Current Role of Laser Interstitial Thermal Therapy in the Treatment of Intracranial Tumors. Asian J Neurosurg 2020; 15:800-808. [PMID: 33708647 PMCID: PMC7869293 DOI: 10.4103/ajns.ajns_185_20] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 05/18/2020] [Accepted: 07/24/2020] [Indexed: 12/19/2022] Open
Abstract
Laser interstitial thermal therapy (LITT) is gaining popularity in the treatment of both primary and secondary intracranial tumors. The goal of LITT is to deliver thermal energy in a predictable, controlled, and minimally invasive fashion. It can be particularly valuable in patients with recurrent tumors who, due to previous radiation or surgery, may have a potentially higher risk of wound breakdown or infection with repeat craniotomy. Deep-seated lesions that are often inaccessible through open approaches (thalamus, hypothalamus, mesial basal temporal lobe, brainstem) may also be suitable targets. The experience and data published thus far on this modality is limited but growing. This review highlights the use of LITT as a primary treatment method in a variety of intracranial tumors, as well as its application as an adjunct to established surgical techniques.
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Affiliation(s)
- Farhan A Mirza
- Department of Neurosurgery, The Montreal Neurological Institute, McGill University, Montreal, QC, Canada.,Department of Neurosurgery, Kentucky Neuroscience Institute, University of Kentucky, Lexington, KY, USA
| | - Rida Mitha
- Department of Surgery, Section of Neurosurgery, The Aga Khan University Hospital, Karachi, Pakistan
| | - Muhammad Shahzad Shamim
- Department of Surgery, Section of Neurosurgery, The Aga Khan University Hospital, Karachi, Pakistan
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28
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Blood-Brain Barrier Modulation to Improve Glioma Drug Delivery. Pharmaceutics 2020; 12:pharmaceutics12111085. [PMID: 33198244 PMCID: PMC7697580 DOI: 10.3390/pharmaceutics12111085] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 11/09/2020] [Accepted: 11/10/2020] [Indexed: 02/07/2023] Open
Abstract
The blood-brain barrier (BBB) is formed by brain microvascular endothelial cells that are sealed by tight junctions, making it a significant obstacle for most brain therapeutics. The poor BBB penetration of newly developed therapeutics has therefore played a major role in limiting their clinical success. A particularly challenging therapeutic target is glioma, which is the most frequently occurring malignant brain tumor. Thus, to enhance therapeutic uptake in tumors, researchers have been developing strategies to modulate BBB permeability. However, most conventional BBB opening strategies are difficult to apply in the clinical setting due to their broad, non-specific modulation of the BBB, which can result in damage to normal brain tissue. In this review, we have summarized strategies that could potentially be used to selectively and efficiently modulate the tumor BBB for more effective glioma treatment.
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29
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Rennert RC, Khan U, Bartek J, Tatter SB, Field M, Toyota B, Fecci PE, Judy K, Mohammadi AM, Landazuri P, Sloan AE, Kim AH, Leuthardt EC, Chen CC. Laser Ablation of Abnormal Neurological Tissue Using Robotic Neuroblate System (LAANTERN): Procedural Safety and Hospitalization. Neurosurgery 2020; 86:538-547. [PMID: 31076762 DOI: 10.1093/neuros/nyz141] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 12/25/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Stereotactic laser ablation (SLA) has demonstrated potential utility for a spectrum of difficult to treat neurosurgical pathologies in multiple small and/or retrospective single-institutional series. Here, we present the safety profile of SLA of intracranial lesions from the Laser Ablation of Abnormal Neurological Tissue using Robotic NeuroBlate System (LAANTERN; Monteris Medical) multi-institutional, international prospective observational registry. OBJECTIVE To determine the procedural safety of SLA for intracranial lesions. METHODS Prospective procedural safety and hospitalization data from the first 100 treated LAANTERN patients was collected and analyzed. RESULTS Mean age and baseline Karnofsky Performance Status (KPS) were 51(± 17) yr and 83(± 15), respectively. In total, 81.2% of patients had undergone prior surgical or radiation treatment. Most patients had a single lesion (79%) ablated through 1 burr hole (1.2 ± 0.7 per patient), immediately following a lesion biopsy. In total, >90% of the lesion was ablated in 72% of treated lesions. Average total procedural time was 188.2 ± 69.6 min, and average blood loss was 17.7 ± 55.6 ccs. The average length of intensive care unit (ICU) and hospital stays before discharge were 38.1 ± 62.7 h and 61.1 ± 87.2 h, respectively. There were 5 adverse events (AEs) attributable to SLA (5/100; 5%). After the procedure, 84.8% of patients were discharged home. There was 1 mortality within 30 d of the procedure (1/100; 1%), which was not attributable to SLA. CONCLUSION SLA is a safe, minimally invasive procedure with favorable postprocedural ICU and hospital utilization profiles.
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Affiliation(s)
- Robert C Rennert
- Department of Neurosurgery, University of California San Diego, San Diego, California
| | - Usman Khan
- Department of Neurosurgery, University of California San Diego, San Diego, California
| | - Jiri Bartek
- Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden.,Department of Neurosurgery, Copenhagen University Hospital Rigshospitalet, Denmark.,Department of Clinical Neuroscience and Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Stephen B Tatter
- Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | | | - Brian Toyota
- Division of Neurosurgery, University of British Columbia, Vancouver, Canada
| | - Peter E Fecci
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina
| | - Kevin Judy
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Alireza M Mohammadi
- Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
| | - Patrick Landazuri
- Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas
| | - Andrew E Sloan
- Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Albert H Kim
- Department of Neurosurgery, Washington University, St. Louis, Missouri
| | - Eric C Leuthardt
- Department of Neurosurgery, Washington University, St. Louis, Missouri
| | - Clark C Chen
- Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota
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30
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Luther E, Mansour S, Echeverry N, McCarthy D, Eichberg DG, Shah A, Nada A, Berry K, Kader M, Ivan M, Komotar R. Laser Ablation for Cerebral Metastases. Neurosurg Clin N Am 2020; 31:537-547. [DOI: 10.1016/j.nec.2020.06.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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31
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Hong CS, Kundishora AJ, Elsamadicy AA, Chiang VL. Laser interstitial thermal therapy in neuro-oncology applications. Surg Neurol Int 2020; 11:231. [PMID: 32874734 PMCID: PMC7451173 DOI: 10.25259/sni_496_2019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 07/22/2020] [Indexed: 12/14/2022] Open
Abstract
Background: Laser interstitial thermal therapy (LITT) is a minimally invasive surgical treatment for multiple intracranial pathologies that are of growing interest to neurosurgeons and their patients and is emerging as an effective alternative to standard of care open surgery in the neurosurgical armamentarium. This option was initially considered for those patients with medical comorbidities and lesion-specific characteristics that confer excessively high risk for resection through a standard craniotomy approach but indications are changing. Methods: The PubMed database was searched for studies in the English literature on LITT for the treatment of primary and metastatic brain tumors, meningiomas, as well as for radiation necrosis (RN) in previously irradiated brain tumors. Results: This review provides an update of the relevant literature regarding application of LITT in neurosurgical oncology for the treatment of de novo and recurrent primary gliomas and brain metastases radiographically regrowing after previous irradiation as recurrent tumor or RN. In addition, this review details the limited experience of LITT with meningiomas and symptomatic peritumoral edema after radiosurgery. The advantages and disadvantages, indications, and comparisons to standard of care treatments such as craniotomy for open surgical resection are discussed for each pathology. Finally, the literature on cost-benefit analyses for LITT are reviewed. Conclusion: The studies discussed in this review have helped define the role of LITT in neurosurgical oncology and delineate optimal patient selection and tumor characteristics most suitable to this intervention.
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Affiliation(s)
- Christopher S Hong
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, United States
| | - Adam J Kundishora
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, United States
| | - Aladine A Elsamadicy
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, United States
| | - Veronica L Chiang
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, United States
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32
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Lahiff MN, Ghali MGZ. The Ethical Dilemma in the Surgical Management of Low Grade Gliomas According to the Variable Availability of Resources and Surgeon Experience. Asian J Neurosurg 2020; 15:266-271. [PMID: 32656117 PMCID: PMC7335147 DOI: 10.4103/ajns.ajns_296_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 12/20/2019] [Indexed: 11/04/2022] Open
Abstract
Low grade gliomas (LGGs) affect young individuals in the prime of life. Management may alternatively include biopsy and observation or surgical resection. Recent evidence strongly favors maximal and supramaximal resection of LGGs in optimizing survival metrics. Awake craniotomy with cortical mapping and electrical stimulation along with other preoperative and intraoperative surgical adjuncts, including intraoperative magnetic resonance and diffusion tensor imaging, facilitates maximization of resection and eschews precipitating neurological deficits. Intraoperative imaging permits additional resection of identified residual to be completed within the same surgical session, improving extent of resection and consequently progression free and overall survival. These resources are available in only a few centers throughout the United States, raising an ethical dilemma as to where patients harboring LGGs should most appropriately be treated.
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Affiliation(s)
- Marshall Norman Lahiff
- School of Law, University of Miami, Miami, Florida, USA.,Walton Lantaff Schoreder and Carson LLP, Miami, Florida, USA
| | - Michael George Zaki Ghali
- Department of Neurological Surgery, Houston Methodist Hospital, Houston, Texas, Philadelphia, Pennsylvania, USA.,Department of Neurobiology and Anatomy, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
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Mahammedi A, Bachir S, Escott EJ, Barnett GH, Mohammadi AM, Larvie M. Prediction of recurrent glioblastoma after laser interstitial thermal therapy: The role of diffusion imaging. Neurooncol Adv 2020; 1:vdz021. [PMID: 32642657 PMCID: PMC7212867 DOI: 10.1093/noajnl/vdz021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Evaluate the utility of diffusion-weighted imaging (DWI) for the assessment of local recurrence of glioblastoma (GBM) on imaging performed 24 h following MRI-guided laser interstitial thermal therapy (LITT). We hypothesize that microscopic peritumoral infiltration correlates with early subtle variations on DWI images and apparent diffusion coefficient (ADC) maps. Methods Of 64 patients with GBM treated with LITT, 39 had MRI scans within 24 h after undergoing LITT. Patterns on DWI images and ADC maps 24 h following LITT were correlated with areas of future GBM recurrence identified through coregistration of subsequent MRI examinations. In the areas of suspected recurrence within the periphery of post-LITT lesions, signal intensity values on ADC maps were recorded and compared with the remaining peritumoral ring. Results Thirty-nine patients with GBM met the inclusion criteria. For predicting recurrent GBM, areas of decreased DWI signal and increased signal on ADC maps within the expected peritumoral ring of restricted diffusion identified 24 h following LITT showed 86.1% sensitivity, 75.2% specificity, and high correlation (r = 0.53) with future areas of GBM recurrence (P < .01). Areas of future recurrence demonstrated a 37% increase in the ADC value (P < .001), compared with findings in the surrounding treated peritumoral region. A significantly greater area under the receiver operating characteristics curve was determined for ADC values (P < .01). Conclusions DWI obtained 24 h following LITT can help predict the location of GBM recurrence months before the development of abnormal enhancement. This may alter future treatment planning, perhaps suggesting areas that may be targeted for additional therapy.
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Affiliation(s)
| | - Suha Bachir
- Department of Pediatrics and Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Edward J Escott
- Department of Radiology, University of Kentucky, Lexington, Kentucky
| | - Gene H Barnett
- Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio.,Department of Neurosurgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio
| | - Alireza M Mohammadi
- Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio.,Department of Neurosurgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio
| | - Mykol Larvie
- Department of Radiology, Cleveland Clinic, Cleveland, Ohio
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Srinivasan ES, Sankey EW, Grabowski MM, Chongsathidkiet P, Fecci PE. The intersection between immunotherapy and laser interstitial thermal therapy: a multipronged future of neuro-oncology. Int J Hyperthermia 2020; 37:27-34. [PMID: 32672126 PMCID: PMC11229985 DOI: 10.1080/02656736.2020.1746413] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 03/04/2020] [Accepted: 03/15/2020] [Indexed: 10/23/2022] Open
Abstract
The rise of immunotherapy (IT) in oncological treatment has greatly improved outcomes in a number of disease states. However, its use in tumors of the central nervous system (CNS) remains limited for multiple reasons related to the unique immunologic tumor microenvironment. As such, it is valuable to consider the intersection of IT with additional treatment methods that may improve access to the CNS and effectiveness of existing IT modalities. One such combination is the pairing of IT with localized hyperthermia (HT) generated through technologies such as laser interstitial thermal therapy (LITT). The wide-ranging immunomodulatory effects of localized and whole-body HT have been investigated for some time. Hyperthermia has demonstrated immunostimulatory effects at the level of tumor cells, immune cells, and the broader environment governing potential immune surveillance. A thorough understanding of these effects as well as the current and upcoming investigations of such in combination with IT is important in considering the future directions of neuro-oncology.
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Affiliation(s)
- Ethan S Srinivasan
- Department of Neurosurgery, Duke University School of Medicine, Durham, NC, USA
| | - Eric W Sankey
- Department of Neurosurgery, Duke University School of Medicine, Durham, NC, USA
- Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA
| | | | | | - Peter E Fecci
- Department of Neurosurgery, Duke University School of Medicine, Durham, NC, USA
- Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA
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35
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Skandalakis GP, Rivera DR, Rizea CD, Bouras A, Raj JGJ, Bozec D, Hadjipanayis CG. Hyperthermia treatment advances for brain tumors. Int J Hyperthermia 2020; 37:3-19. [PMID: 32672123 PMCID: PMC7756245 DOI: 10.1080/02656736.2020.1772512] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 04/15/2020] [Accepted: 05/16/2020] [Indexed: 02/06/2023] Open
Abstract
Hyperthermia therapy (HT) of cancer is a well-known treatment approach. With the advent of new technologies, HT approaches are now important for the treatment of brain tumors. We review current clinical applications of HT in neuro-oncology and ongoing preclinical research aiming to advance HT approaches to clinical practice. Laser interstitial thermal therapy (LITT) is currently the most widely utilized thermal ablation approach in clinical practice mainly for the treatment of recurrent or deep-seated tumors in the brain. Magnetic hyperthermia therapy (MHT), which relies on the use of magnetic nanoparticles (MNPs) and alternating magnetic fields (AMFs), is a new quite promising HT treatment approach for brain tumors. Initial MHT clinical studies in combination with fractionated radiation therapy (RT) in patients have been completed in Europe with encouraging results. Another combination treatment with HT that warrants further investigation is immunotherapy. HT approaches for brain tumors will continue to a play an important role in neuro-oncology.
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Affiliation(s)
- Georgios P. Skandalakis
- Brain Tumor Nanotechnology Laboratory, Department of Neurosurgery, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Daniel R. Rivera
- Brain Tumor Nanotechnology Laboratory, Department of Neurosurgery, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Caroline D. Rizea
- Brain Tumor Nanotechnology Laboratory, Department of Neurosurgery, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Alexandros Bouras
- Brain Tumor Nanotechnology Laboratory, Department of Neurosurgery, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Joe Gerald Jesu Raj
- Brain Tumor Nanotechnology Laboratory, Department of Neurosurgery, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Dominique Bozec
- Brain Tumor Nanotechnology Laboratory, Department of Neurosurgery, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Constantinos G. Hadjipanayis
- Brain Tumor Nanotechnology Laboratory, Department of Neurosurgery, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
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Arocho-Quinones EV, Lew SM, Handler MH, Tovar-Spinoza Z, Smyth M, Bollo R, Donahue D, Perry MS, Levy ML, Gonda D, Mangano FT, Storm PB, Price AV, Couture DE, Oluigbo C, Duhaime AC, Barnett GH, Muh CR, Sather MD, Fallah A, Wang AC, Bhatia S, Patel K, Tarima S, Graber S, Huckins S, Hafez DM, Rumalla K, Bailey L, Shandley S, Roach A, Alexander E, Jenkins W, Tsering D, Price G, Meola A, Evanoff W, Thompson EM, Brandmeir N. Magnetic resonance-guided stereotactic laser ablation therapy for the treatment of pediatric brain tumors: a multiinstitutional retrospective study. J Neurosurg Pediatr 2020; 26:13-21. [PMID: 32217793 PMCID: PMC7885863 DOI: 10.3171/2020.1.peds19496] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Accepted: 01/22/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This study aimed to assess the safety and efficacy of MR-guided stereotactic laser ablation (SLA) therapy in the treatment of pediatric brain tumors. METHODS Data from 17 North American centers were retrospectively reviewed. Clinical, technical, and radiographic data for pediatric patients treated with SLA for a diagnosis of brain tumor from 2008 to 2016 were collected and analyzed. RESULTS A total of 86 patients (mean age 12.2 ± 4.5 years) with 76 low-grade (I or II) and 10 high-grade (III or IV) tumors were included. Tumor location included lobar (38.4%), deep (45.3%), and cerebellar (16.3%) compartments. The mean follow-up time was 24 months (median 18 months, range 3-72 months). At the last follow-up, the volume of SLA-treated tumors had decreased in 80.6% of patients with follow-up data. Patients with high-grade tumors were more likely to have an unchanged or larger tumor size after SLA treatment than those with low-grade tumors (OR 7.49, p = 0.0364). Subsequent surgery and adjuvant treatment were not required after SLA treatment in 90.4% and 86.7% of patients, respectively. Patients with high-grade tumors were more likely to receive subsequent surgery (OR 2.25, p = 0.4957) and adjuvant treatment (OR 3.77, p = 0.1711) after SLA therapy, without reaching significance. A total of 29 acute complications in 23 patients were reported and included malpositioned catheters (n = 3), intracranial hemorrhages (n = 2), transient neurological deficits (n = 11), permanent neurological deficits (n = 5), symptomatic perilesional edema (n = 2), hydrocephalus (n = 4), and death (n = 2). On long-term follow-up, 3 patients were reported to have worsened neuropsychological test results. Pre-SLA tumor volume, tumor location, number of laser trajectories, and number of lesions created did not result in a significantly increased risk of complications; however, the odds of complications increased by 14% (OR 1.14, p = 0.0159) with every 1-cm3 increase in the volume of the lesion created. CONCLUSIONS SLA is an effective, minimally invasive treatment option for pediatric brain tumors, although it is not without risks. Limiting the volume of the generated thermal lesion may help decrease the incidence of complications.
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Affiliation(s)
| | - Sean M. Lew
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
- Department of Neurosurgery, Children’s Hospital of Wisconsin, Milwaukee, Wisconsin
| | - Michael H. Handler
- Department of Neurosurgery, Children’s Hospital Colorado, Aurora, Colorado
| | - Zulma Tovar-Spinoza
- Department of Neurosurgery, SUNY Upstate Medical University, Syracuse, New York
| | - Matthew Smyth
- Department of Neurosurgery, St. Louis Children’s Hospital, St. Louis, Missouri
| | - Robert Bollo
- Department of Neurosurgery, Primary Children’s Hospital, Salt Lake City, Utah
| | - David Donahue
- Department of Neurosurgery, Cook Children’s Hospital, Fort Worth, Texas
| | - M. Scott Perry
- Department of Neurology, Cook Children’s Hospital, Fort Worth, Texas
| | - Michael L. Levy
- Department of Neurosurgery, Rady Children’s Hospital-San Diego, California
| | - David Gonda
- Department of Neurosurgery, Rady Children’s Hospital-San Diego, California
| | | | - Phillip B. Storm
- Department of Neurosurgery, Children’s Hospital of Philadelphia, Pennsylvania
| | - Angela V. Price
- Department of Neurosurgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Daniel E. Couture
- Department of Neurosurgery, Wake Forest Baptist Health, Winston-Salem, North Carolina
| | - Chima Oluigbo
- Department of Neurosurgery, Children’s National Health System, Washington, DC
| | - Ann-Christine Duhaime
- Department of Neurosurgery, Massachusetts General Hospital for Children, Boston, Massachusetts
| | - Gene H. Barnett
- Department of Neurosurgery, Cleveland Clinic Children’s, Cleveland, Ohio
| | - Carrie R. Muh
- Department of Neurosurgery, Duke Children’s Hospital, Durham, North Carolina
| | - Michael D. Sather
- Department of Neurosurgery, Penn State Health, Hershey, Pennsylvania
| | - Aria Fallah
- Department of Neurosurgery, UCLA Mattel Children’s Hospital, Los Angeles, California
| | - Anthony C. Wang
- Department of Neurosurgery, UCLA Mattel Children’s Hospital, Los Angeles, California
| | - Sanjiv Bhatia
- Department of Neurosurgery, Nicklaus Children’s Hospital, Miami, Florida
| | - Kadam Patel
- Department of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Sergey Tarima
- Department of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Sarah Graber
- Department of Neurosurgery, Children’s Hospital Colorado, Aurora, Colorado
| | - Sean Huckins
- Department of Neurosurgery, SUNY Upstate Medical University, Syracuse, New York
| | - Daniel M. Hafez
- Department of Neurosurgery, St. Louis Children’s Hospital, St. Louis, Missouri
| | - Kavelin Rumalla
- Department of Neurosurgery, St. Louis Children’s Hospital, St. Louis, Missouri
| | - Laurie Bailey
- Department of Neurosurgery, Cook Children’s Hospital, Fort Worth, Texas
| | - Sabrina Shandley
- Department of Neurosurgery, Cook Children’s Hospital, Fort Worth, Texas
| | - Ashton Roach
- Department of Neurosurgery, Cincinnati Children’s Hospital, Cincinnati, Ohio
| | - Erin Alexander
- Department of Neurosurgery, Children’s Hospital of Philadelphia, Pennsylvania
| | - Wendy Jenkins
- Department of Neurosurgery, Wake Forest Baptist Health, Winston-Salem, North Carolina
| | - Deki Tsering
- Department of Neurosurgery, Children’s National Health System, Washington, DC
| | - George Price
- Department of Neurosurgery, Massachusetts General Hospital for Children, Boston, Massachusetts
| | - Antonio Meola
- Department of Neurosurgery, Cleveland Clinic Children’s, Cleveland, Ohio
| | - Wendi Evanoff
- Department of Neurosurgery, Cleveland Clinic Children’s, Cleveland, Ohio
| | - Eric M. Thompson
- Department of Neurosurgery, Duke Children’s Hospital, Durham, North Carolina
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Montemurro N, Anania Y, Cagnazzo F, Perrini P. Survival outcomes in patients with recurrent glioblastoma treated with Laser Interstitial Thermal Therapy (LITT): A systematic review. Clin Neurol Neurosurg 2020; 195:105942. [PMID: 32470780 DOI: 10.1016/j.clineuro.2020.105942] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/14/2020] [Accepted: 05/17/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To study the role of laser interstitial thermal therapy in recurrent glioblastoma and to assess its effect in the overall survival and in progression-free survival. METHODS A MEDLINE and Pubmed search was performed for the key words "laser interstitial thermal therapy", "LITT" and "glioblastoma". Studies investigating overall survival and progression-free survival of recurrent glioblastoma after laser interstitial thermal therapy were selected. RESULTS A total of 17 studies met the selection criteria, accounting for 203 patients with recurrent glioblastoma who underwent 219 laser interstitial thermal therapy treatments. The median age was 57.4 years and there was male predominance (65.8 % male Vs 34.2 % female). The most common location resulted frontal lobe (29 %), followed by temporal (23.9 %), parietal (21.4 %) and occipital lobes (2.6 %). Additional locations included thalamus, corpus callosum and cerebellum (23.1 %). Pre-treatment median tumor size was 8.9 cm3. Morbidity was 6.4 % with a median hospital stay of 3.5 days. The most common complications were seizures (2%), motor deficits (1.5 %), wound infection (1.5 %), transient hemiparesis (1%) and hemorrhage (0.5 %). No deaths were reported due to LITT procedure. The median progression-free survival and the median overall survival after laser interstitial thermal therapy resulted 5.6 months and 10.2 months, respectively. The median overall survival from diagnosis was 14.7 months. All patients underwent adjuvant chemotherapy after treatment. CONCLUSION Laser interstitial thermal therapy provides an effective treatment with low morbidity for selected patients harboring recurrent glioblastoma. Laser interstitial thermal therapy should be included in the armamentarium of neurosurgical oncologist for treatment of recurrent glioblastomas.
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Affiliation(s)
- Nicola Montemurro
- Department of Neurosurgery, Azienda Ospedaliera Universitaria Pisana (AOUP), Pisa, Italy; Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy.
| | - Yury Anania
- Department of Neurosurgery, Azienda Ospedaliera Universitaria Pisana (AOUP), Pisa, Italy
| | - Federico Cagnazzo
- Neuroradiology Department, CHRU Gui de Chauliac, Montpellier, France
| | - Paolo Perrini
- Department of Neurosurgery, Azienda Ospedaliera Universitaria Pisana (AOUP), Pisa, Italy; Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
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Wang D, Wang C, Wang L, Chen Y. A comprehensive review in improving delivery of small-molecule chemotherapeutic agents overcoming the blood-brain/brain tumor barriers for glioblastoma treatment. Drug Deliv 2020; 26:551-565. [PMID: 31928355 PMCID: PMC6534214 DOI: 10.1080/10717544.2019.1616235] [Citation(s) in RCA: 92] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Glioblastoma (GBM) is the most common and lethal primary brain tumor which is highly resistant to conventional radiotherapy and chemotherapy, and cannot be effectively controlled by surgical resection. Due to inevitable recurrence of GBM, it remains essentially incurable with a median overall survival of less than 18 months after diagnosis. A great challenge in current therapies lies in the abrogated delivery of most of the chemotherapeutic agents to the tumor location in the presence of blood-brain barrier (BBB) and blood-brain tumor barrier (BBTB). These protective barriers serve as a selectively permeable hurdle reducing the efficacy of anti-tumor drugs in GBM therapy. This work systematically gives a comprehensive review on: (i) the characteristics of the BBB and the BBTB, (ii) the influence of BBB/BBTB on drug delivery and the screening strategy of small-molecule chemotherapeutic agents with promising BBB/BBTB-permeable potential, (iii) the strategies to overcome the BBB/BBTB as well as the techniques which can lead to transient BBB/BBTB opening or disruption allowing for improving BBB/BBTB-penetration of drugs. It is hoped that this review provide practical guidance for the future development of small BBB/BBTB-permeable agents against GBM as well as approaches enhancing drug delivery across the BBB/BBTB to GBM.
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Affiliation(s)
- Da Wang
- State Key Laboratory of Medicinal Chemical Biology, Nankai University, Tianjin, China
| | - Chao Wang
- Department of Chemistry, Yale University, New Haven, CT, USA
| | - Liang Wang
- State Key Laboratory of Medicinal Chemical Biology, Nankai University, Tianjin, China
| | - Yue Chen
- State Key Laboratory of Medicinal Chemical Biology, Nankai University, Tianjin, China
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Mohammadi AM, Sharma M, Beaumont TL, Juarez KO, Kemeny H, Dechant C, Seas A, Sarmey N, Lee BS, Jia X, Fecci PE, Baehring J, Moliterno J, Chiang VL, Ahluwalia MS, Kim AH, Barnett GH, Leuthardt EC. Upfront Magnetic Resonance Imaging-Guided Stereotactic Laser-Ablation in Newly Diagnosed Glioblastoma: A Multicenter Review of Survival Outcomes Compared to a Matched Cohort of Biopsy-Only Patients. Neurosurgery 2020; 85:762-772. [PMID: 30476325 DOI: 10.1093/neuros/nyy449] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 08/21/2018] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Laser ablation (LA) is used as an upfront treatment in patients with deep seated newly diagnosed Glioblastoma (nGBM). OBJECTIVE To evaluate the outcomes of LA in patients with nGBM and compare them with a matched biopsy-only cohort. METHODS Twenty-four nGBM patients underwent upfront LA at Cleveland clinic, Washington University in St. Louis, and Yale University (6/2011-12/2014) followed by chemo/radiotherapy. Also, 24 out of 171 nGBM patients with biopsy followed by chemo/radiotherapy were matched based on age (< 70 vs ≥ 70), gender, tumor location (deep vs lobar), and volume (<11 cc vs ≥11 cc). Progression-free survival (PFS), overall survival (OS), and disease-specific PFS and OS were outcome measures. Three prognostic groups were identified based on extent of tumor ablation by thermal-damage-threshold (TDT)-lines. RESULTS The median tumor volume in LA (n = 24) and biopsy only (n = 24) groups was 9.3 cm3 and 8.2 cm3 respectively. Overall, median estimate of OS and PFS in LA cohort was 14.4 and 4.3 mo compared to 15.8 mo and 5.9 mo for biopsy only cohort. On multivariate analysis, favorable TDT-line prognostic groups were associated with lower incidence of disease specific death (P = .03) and progression (P = .05) compared to other groups including biopsy only cohort. Only age (<70 yr, P = .02) and tumor volume (<11 cc, P = .03) were favorable prognostic factors for OS. CONCLUSION The maximum tumor coverage by LA followed by radiation/chemotherapy is an effective treatment modality in patients with nGBM, compared to biopsy only cohort. The TDT-line prognostic groups were independent predictor of disease specific death and progression after LA.
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Affiliation(s)
- Alireza M Mohammadi
- The Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Department of Neurosurgery, Neurological Institute, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio
| | - Mayur Sharma
- The Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Department of Neurosurgery, Neurological Institute, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio
| | - Thomas L Beaumont
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri
| | - Kevin O Juarez
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut
| | - Hanna Kemeny
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina
| | - Cosette Dechant
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina
| | - Andreas Seas
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina
| | - Nehaw Sarmey
- The Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Department of Neurosurgery, Neurological Institute, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio
| | - Bryan S Lee
- The Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Department of Neurosurgery, Neurological Institute, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio
| | - Xuefei Jia
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Peter E Fecci
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina
| | - Joachim Baehring
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut
| | - Jennifer Moliterno
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut
| | - Veronica L Chiang
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut
| | - Manmeet S Ahluwalia
- The Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Department of Neurosurgery, Neurological Institute, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio
| | - Albert H Kim
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri
| | - Gene H Barnett
- The Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Department of Neurosurgery, Neurological Institute, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio
| | - Eric C Leuthardt
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri
- Department of Biomedical Engineering, Center for Innovation in Neuroscience and Technology, Washington University School of Medicine, St. Louis, Missouri
- Department of Mechanical Engineering and Material Science, Center for Innovation in Neuroscience and Technology, Washington University, School of Medicine, St. Louis, Missouri
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Bozinov O, Yang Y, Oertel MF, Neidert MC, Nakaji P. Laser interstitial thermal therapy in gliomas. Cancer Lett 2020; 474:151-157. [PMID: 31991153 DOI: 10.1016/j.canlet.2020.01.024] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 01/16/2020] [Accepted: 01/22/2020] [Indexed: 12/14/2022]
Abstract
Laser interstitial thermal therapy (LITT) has been used for brain metastasis, epilepsy, and necrosis, as well as gliomas as a minimally invasive treatment for many years. With the improvement of the thermal monitoring and ablation precision, especially the application of magnetic resonance (MR) thermography in the procedure and the available two commercial laser systems nowadays, LITT is gradually accepted by more neurosurgical centers. Recently, some new concepts, for example the adjuvant chemotherapy or radiation following LITT, the combination of immunotherapy and LITT regarding the glioma treatment are proposed and currently being investigated. The aim of this study is to summarize the evolution of LITT especially for brain gliomas and a possible outlook of the future.
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Affiliation(s)
- Oliver Bozinov
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8002, Zurich, Switzerland.
| | - Yang Yang
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8002, Zurich, Switzerland
| | - Markus F Oertel
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8002, Zurich, Switzerland
| | - Marian C Neidert
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8002, Zurich, Switzerland; Department of Pathology and Center for Cancer Research, Massachusetts General Hospital and Harvard Medical School, Boston, MA, 02114, USA; Broad Institute of Harvard and MIT, Cambridge, MA, 02142, USA
| | - Peter Nakaji
- Department of Neurosurgery, University of Arizona College of Medicine Phoenix, Banner Health, 755 East McDowell Road, Phoenix, AZ, 85006, USA
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Munier SM, Hargreaves EL, Patel NV, Danish SF. Ablation dynamics of subsequent thermal doses delivered to previously heat-damaged tissue during magnetic resonance-guided laser-induced thermal therapy. J Neurosurg 2019; 131:1958-1965. [PMID: 30579274 DOI: 10.3171/2018.7.jns18886] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Accepted: 07/31/2018] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Intraoperative dynamics of magnetic resonance-guided laser-induced thermal therapy (MRgLITT) have been previously characterized for ablations of naive tissue. However, most treatment sessions require the delivery of multiple doses, and little is known about the ablation dynamics when additional doses are applied to heat-damaged tissue. This study investigated the differences in ablation dynamics between naive versus damaged tissue. METHODS The authors examined 168 ablations from 60 patients across various surgical indications. All ablations were performed using the Visualase MRI-guided laser ablation system (Medtronic), which employs a 980-nm diffusing tip diode laser. Cases with multiple topographically overlapping doses with constant power were selected for this study. Single-dose intraoperative thermal damage was used to calculate ablation rate based on the thermal damage estimate (TDE) of the maximum area of ablation achieved (TDEmax) and the total duration of ablation (tmax). We compared ablation rates of naive undamaged tissue and damaged tissue exposed to subsequent thermal doses following an initial ablation. RESULTS TDEmax was significantly decreased in subsequent ablations compared to the preceding ablation (initial ablation 227.8 ± 17.7 mm2, second ablation 164.1 ± 21.5 mm2, third ablation 124.3 ± 11.2 mm2; p = < 0.001). The ablation rate of subsequent thermal doses delivered to previously damaged tissue was significantly decreased compared to the ablation rate of naive tissue (initial ablation 2.703 mm2/sec; second ablation 1.559 mm2/sec; third ablation 1.237 mm2/sec; fourth ablation 1.076 mm/sec; p = < 0.001). A negative correlation was found between TDEmax and percentage of overlap in a subsequent ablation with previously damaged tissue (r = -0.164; p < 0.02). CONCLUSIONS Ablation of previously ablated tissue results in a reduced ablation rate and reduced TDEmax. Additionally, each successive thermal dose in a series of sequential ablations results in a decreased ablation rate relative to that of the preceding ablation. In the absence of a change in power, operators should anticipate a possible reduction in TDE when ablating partially damaged tissue for a similar amount of time compared to the preceding ablation.
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Laurent D, Oliveria SF, Shang M, Bova F, Freedman R, Rahman M. Techniques to Ensure Accurate Targeting for Delivery of Awake Laser Interstitial Thermotherapy. Oper Neurosurg (Hagerstown) 2019; 15:454-460. [PMID: 29444286 DOI: 10.1093/ons/opx290] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 12/23/2017] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Magnetic resonance imaging (MRI) guided laser interstitial thermal therapy (LITT) is an emerging neurosurgical treatment modality that is typically performed under general anesthesia. We describe a novel workflow developed at the University of Florida to deliver LITT in conscious patients without the use of general anesthesia. OBJECTIVE To describe a novel workflow for LITT implementation in the awake patient with equivalent treatment results when compared to procedures performed under general anesthesia. METHODS For trajectories near a post of the Cosman-Roberts-Wells (CRW) frame (Integra LifeSciences, Plainsboro, New Jersey), we used preoperative MRI imaging to 3-dimensional-print a patient-specific mask with a trajectory guide to indicate the planned entry point during headframe placement. Otherwise, routine headframe placement and stereotactic registration were performed. Stereotactic biopsy and placement of the cranial bolt were performed in a standard neurosurgical operating room. The patient was transferred to a diagnostic MRI suite and positioned in the MRI scanner using beanbags and a custom molded thermoplastic mask. LITT was delivered with the patient conscious in the MRI scanner according to the manufacturer's recommendations. We collected patient demographics, treatment time, length of stay, and calculated preoperative tumor volume and postoperative ablation volumes. RESULTS Ten sequential patients were treated with LITT from January 2016 until March 2017. The average preoperative tumor volume was 6.9 cm3. The average tissue volume ablated was 18.3 cm3. The mean operative time was 31 min (standard deviation [SD] 10 min) and mean time with laser delivery in MRI was 79 min (SD 27 min). The mean length of stay was 1.4 d (SD 0.9). There were no major complications. CONCLUSION Using trajectory preplanning, customized face masks, and noninvasive head immobilization, LITT can be delivered to patients safely and accurately without general anesthesia.
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Affiliation(s)
- Dimitri Laurent
- Department of Neurosurgery, University of Florida, Gainesville, Florida
| | - Seth F Oliveria
- Department of Neurosurgery, University of Florida, Gainesville, Florida
| | - Michael Shang
- Department of Neurosurgery, University of Florida, Gainesville, Florida
| | - Frank Bova
- Department of Neurosurgery, University of Florida, Gainesville, Florida
| | - Rachel Freedman
- Department of Neurosurgery, University of Florida, Gainesville, Florida
| | - Maryam Rahman
- Department of Neurosurgery, University of Florida, Gainesville, Florida
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Tovar-Spinoza Z, Ziechmann R, Zyck S. Single and staged laser interstitial thermal therapy ablation for cortical tubers causing refractory epilepsy in pediatric patients. Neurosurg Focus 2019; 45:E9. [PMID: 30173608 DOI: 10.3171/2018.6.focus18228] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) is a novel, minimally invasive treatment for the surgical treatment of epilepsy. In this paper, the authors report on clinical outcomes for a series of pediatric patients with tuberous sclerosis complex (TSC) and medication-refractory epileptogenic cortical tubers. METHODS A retrospective chart review was performed at SUNY Upstate Golisano Children's Hospital in Syracuse, New York. The authors included all cases involving pediatric patients (< 18 years) who underwent MRgLITT for ablation of epileptogenic cortical tubers between February 2013 and November 2015. RESULTS Seven patients with cortical tubers were treated (4 female and 3 male). The patients' average age was 6.6 years (range 2-17 years). Two patients had a single procedure, and 5 patients had staged procedures. The mean time between procedures in the staged cases was 6 months. All of the patients had a meaningful reduction in seizure frequency as reported by Engel and ILAE seizure outcome classifications, and most (71.4%) of the patients experienced a reduction in AED burden. Three of the 4 patients who presented with neuropsychiatric symptoms had some improvement in these domains after laser ablation. No perioperative complications were noted. The mean duration of follow-up was 19.3 months (range 4-49 months). CONCLUSIONS Laser ablation represents a minimally invasive alternative to resective epilepsy surgery and is an effective treatment for refractory epilepsy due to cortical tubers.
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Salem U, Kumar VA, Madewell JE, Schomer DF, de Almeida Bastos DC, Zinn PO, Weinberg JS, Rao G, Prabhu SS, Colen RR. Neurosurgical applications of MRI guided laser interstitial thermal therapy (LITT). Cancer Imaging 2019; 19:65. [PMID: 31615562 PMCID: PMC6792239 DOI: 10.1186/s40644-019-0250-4] [Citation(s) in RCA: 96] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 08/30/2019] [Indexed: 02/02/2023] Open
Abstract
MRI-guided laser interstitial thermal therapy (LITT) is the selective ablation of a lesion or a tissue using heat emitted from a laser device. LITT is considered a less invasive technique compared to open surgery that provides a nonsurgical solution for patients who cannot tolerate surgery. Although laser ablation has been used to treat brain lesions for decades, recent advances in MRI have improved lesion targeting and enabled real-time accurate monitoring of the thermal ablation process. These advances have led to a plethora of research involving the technique, safety, and potential applications of LITT.LITT is a minimally invasive treatment modality that shows promising results and is associated with decreased morbidity. It has various applications, such as treatment of glioma, brain metastases, radiation necrosis, and epilepsy. It can provide a safer alternative treatment option for patients in whom the lesion is not accessible by surgery, who are not surgical candidates, or in whom other standard treatment options have failed. Our aim is to review the current literature on LITT and provide a descriptive review of the technique, imaging findings, and clinical applications for neurosurgery.
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Affiliation(s)
- Usama Salem
- Department of Radiology, The University of Texas Medical Branch at Galveston, Galveston, TX, 77555, USA.
| | - Vinodh A Kumar
- Department of Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - John E Madewell
- Department of Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Donald F Schomer
- Department of Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | | | - Pascal O Zinn
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA, 15232, USA
| | - Jeffrey S Weinberg
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Ganesh Rao
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Sujit S Prabhu
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Rivka R Colen
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA, 15232, USA. .,Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, PA, 15232, USA.
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Zhao Y, Luo Y, Guo T, Tang Z, Zhou Z. A Novel Amphiphilic AIE Molecule and Its Application in Thermosensitive Liposome. ChemistrySelect 2019. [DOI: 10.1002/slct.201900976] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Yun‐Hui Zhao
- School of Chemistry and Chemical EngineeringHunan Provincial Key Laboratory of Controllable Preparation and Functional Application of Fine PolymersHunan University of Science and Technology, Xiangtan, Hunan 411201 China
- Key Laboratory of Synthetic Chemistry of Natural SubstancesShanghai Institute of Organic ChemistryChinese Academy of Sciences Shanghai 200032 China
| | - Yueyang Luo
- School of Chemistry and Chemical EngineeringHunan Provincial Key Laboratory of Controllable Preparation and Functional Application of Fine PolymersHunan University of Science and Technology, Xiangtan, Hunan 411201 China
| | - Tao Guo
- College of ChemistryChemical and Environmental EngineeringHenan University of Technology Zhengzhou Henan 450001 China
| | - Zilong Tang
- School of Chemistry and Chemical EngineeringHunan Provincial Key Laboratory of Controllable Preparation and Functional Application of Fine PolymersHunan University of Science and Technology, Xiangtan, Hunan 411201 China
| | - Zhihua Zhou
- School of Chemistry and Chemical EngineeringHunan Provincial Key Laboratory of Controllable Preparation and Functional Application of Fine PolymersHunan University of Science and Technology, Xiangtan, Hunan 411201 China
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46
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Wang L, Liang B, Li YI, Liu X, Huang J, Li YM. What is the advance of extent of resection in glioblastoma surgical treatment-a systematic review. Chin Neurosurg J 2019; 5:2. [PMID: 32922902 PMCID: PMC7398311 DOI: 10.1186/s41016-018-0150-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 12/27/2018] [Indexed: 12/14/2022] Open
Abstract
Glioblastoma multiform (GBM) is the most common malignant brain tumor characterized by poor prognosis, increased invasiveness, and high relapse rates. The relative survival estimates are quite low in spite of the standard treatment for GBM in recent years. Now, it has been gradually accepted that the amount of tumor mass removed correlates with longer survival rates. Although new technique advances allowing intraoperative analysis of tumor and normal brain tissue and functional paradigms based on stimulation techniques to map eloquent areas have been used for GBM resection, visual identification of tumor margins still remains a challenge for neurosurgeons. This article attempts to review and summarize the evolution of surgical resection for glioblastomas.
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Affiliation(s)
- Lei Wang
- Department of Neurosurgery and Radiology, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY 14642 USA.,Department of Neurosurgery, The Affiliated Hospital of Xuzhou Medical University, 99 Huaihai West Road, Xuzhou, 221002 Jiangsu Province China
| | - Buqing Liang
- Department of Neurosurgery, Baylor Scott & White Health, Temple, TX 76508 USA
| | - Yan Icy Li
- Department of Neurosurgery and Radiology, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY 14642 USA.,Department of Bioinformatics, Nanjing Medical University, Nanjing, 211166 China
| | - Xiang Liu
- Department of Neurosurgery and Radiology, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY 14642 USA
| | - Jason Huang
- Department of Neurosurgery, Baylor Scott & White Health, Temple, TX 76508 USA
| | - Yan Michael Li
- Department of Neurosurgery and Radiology, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY 14642 USA
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Willie JT, Malcolm JG, Stern MA, Lowder LO, Neill SG, Cabaniss BT, Drane DL, Gross RE. Safety and effectiveness of stereotactic laser ablation for epileptogenic cerebral cavernous malformations. Epilepsia 2019; 60:220-232. [PMID: 30653657 PMCID: PMC6365175 DOI: 10.1111/epi.14634] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 12/08/2018] [Accepted: 12/09/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Magnetic resonance (MR) thermography-guided laser interstitial thermal therapy, or stereotactic laser ablation (SLA), is a minimally invasive alternative to open surgery for focal epilepsy caused by cerebral cavernous malformations (CCMs). We examined the safety and effectiveness of SLA of epileptogenic CCMs. METHODS We retrospectively analyzed 19 consecutive patients who presented with focal seizures associated with a CCM. Each patient underwent SLA of the CCM and adjacent cortex followed by standard clinical and imaging follow-up. RESULTS All but one patient had chronic medically refractory epilepsy (median duration 8 years, range 0.5-52 years). Lesions were located in the temporal (13), frontal (five), and parietal (one) lobes. CCMs induced magnetic susceptibility artifacts during thermometry, but perilesional cortex was easily visualized. Fourteen of 17 patients (82%) with >12 months of follow-up achieved Engel class I outcomes, of which 10 (59%) were Engel class IA. Two patients who were not seizure-free from SLA alone became so following intracranial electrode-guided open resection. Delayed postsurgical imaging validated CCM involution (median 83% volume reduction) and ablation of surrounding cortex. Histopathologic examination of one previously ablated CCM following open surgery confirmed obliteration. SLA caused no detectable hemorrhages. Two symptomatic neurologic deficits (visual and motor) were predictable, and neither was permanently disabling. SIGNIFICANCE In a consecutive retrospective series, MR thermography-guided SLA was an effective alternative to open surgery for epileptogenic CCM. The approach was free of hemorrhagic complications, and clinically significant neurologic deficits were predictable. SLA presents no barrier to subsequent open surgery when needed.
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Affiliation(s)
- Jon T. Willie
- Department of Neurological Surgery, Emory University School
of Medicine. Atlanta, GA
- Department of Neurology, Emory University School of
Medicine. Atlanta, GA
| | - James G. Malcolm
- Department of Neurological Surgery, Emory University School
of Medicine. Atlanta, GA
| | - Matthew A. Stern
- Medical Scientist Training Program, Emory University School
of Medicine. Atlanta, GA
| | - Lindsay O. Lowder
- Department of Pathology, Emory University School of
Medicine. Atlanta, GA
| | - Stewart G. Neill
- Department of Pathology, Emory University School of
Medicine. Atlanta, GA
| | - Brian T. Cabaniss
- Department of Neurology, Emory University School of
Medicine. Atlanta, GA
| | - Daniel L. Drane
- Department of Neurology, Emory University School of
Medicine. Atlanta, GA
- Department of Pediatrics, Emory University School of
Medicine. Atlanta, GA
- Department of Neurology, University of Washington School of
Medicine, Seattle, WA
| | - Robert E. Gross
- Department of Neurological Surgery, Emory University School
of Medicine. Atlanta, GA
- Department of Neurology, Emory University School of
Medicine. Atlanta, GA
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Odéen H, Parker DL. Improved MR thermometry for laser interstitial thermotherapy. Lasers Surg Med 2019; 51:286-300. [PMID: 30645017 DOI: 10.1002/lsm.23049] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2018] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To develop, test and evaluate improved 2D and 3D protocols for proton resonance frequency shift magnetic resonance temperature imaging (MRTI) of laser interstitial thermal therapy (LITT). The objective was to develop improved MRTI protocols in terms of temperature measurement precision and volume coverage compared to the 2D MRTI protocol currently used with a commercially available LITT system. METHODS Four different 2D protocols and four different 3D protocols were investigated. The 2D protocols used multi-echo readouts to prolong the total MR sampling time and hence the MRTI precision, without prolonging the total acquisition time. The 3D protocols provided volumetric thermometry by acquiring a slab of 12 contiguous slices in the same acquisition time as the 2D protocols. The study only considered readily available pulse sequences (Cartesian 2D and 3D gradient recalled echo and echo planar imaging [EPI]) and methods (partial Fourier and parallel imaging) to ensure wide availability and rapid clinical implementation across vendors and field strengths. In vivo volunteer studies were performed to investigate and compare MRTI precision and image quality. Phantom experiments with LITT heating were performed to investigate and compare MRTI precision and accuracy. Different coil setups were used in the in vivo studies to assess precision differences between using local (such as flex and head coils) and non-local (i.e., body coil) receive coils. Studies were performed at both 1.5 T and 3 T. RESULTS The improved 2D protocols provide up to a factor of two improvement in the MRTI precision in the same acquisition time, compared to the currently used clinical protocol. The 3D echo planar imaging protocols provide comparable precision as the currently used 2D clinical protocol, but over a substantially larger field of view, without increasing the acquisition time. As expected, local receive coils perform substantially better than the body coil, and 3 T provides better MRTI accuracy and precision than 1.5 T. 3D data can be zero-filled interpolated in all three dimensions (as opposed to just two dimensions for 2D data), reducing partial volume effects and measuring higher maximum temperature rises. CONCLUSIONS With the presented protocols substantially improved MRTI precision (for 2D imaging) or greatly improved field of view coverage (for 3D imaging) can be achieved in the same acquisition time as the currently used protocol. Only widely available pulse sequences and acquisition methods were investigated, which should ensure quick translation to the clinic. Lasers Surg. Med. 51:286-300, 2019. © 2019 Wiley Periodicals, Inc.
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Affiliation(s)
- Henrik Odéen
- Utah Center for Advanced Imaging Research, Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah
| | - Dennis L Parker
- Utah Center for Advanced Imaging Research, Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah
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Han SJ, Chang SM, Berger MS. Laser Ablation vs Open Resection for Deep-Seated Tumors: The Case for Open Resection. Neurosurgery 2018; 63 Suppl 1:10-14. [PMID: 27399358 DOI: 10.1227/neu.0000000000001288] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Seunggu J Han
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
| | - Susan M Chang
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
| | - Mitchel S Berger
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
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50
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Brighi C, Puttick S, Rose S, Whittaker AK. The potential for remodelling the tumour vasculature in glioblastoma. Adv Drug Deliv Rev 2018; 136-137:49-61. [PMID: 30308226 DOI: 10.1016/j.addr.2018.10.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 10/04/2018] [Accepted: 10/07/2018] [Indexed: 12/19/2022]
Abstract
Despite significant improvements in the clinical management of glioblastoma, poor delivery of systemic therapies to the entire population of tumour cells remains one of the biggest challenges in the achievement of more effective treatments. On the one hand, the abnormal and dysfunctional tumour vascular network largely limits blood perfusion, resulting in an inhomogeneous delivery of drugs to the tumour. On the other hand, the presence of an intact blood-brain barrier (BBB) in certain regions of the tumour prevents chemotherapeutic drugs from permeating through the tumour vessels and reaching the diseased cells. In this review we analyse in detail the implications of the presence of a dysfunctional vascular network and the impenetrable BBB on drug transport. We discuss advantages and limitations of the currently available strategies for remodelling the tumour vasculature aiming to ameliorate the above mentioned limitations. Finally we review research methods for visualising vascular dysfunction and highlight the power of DCE- and DSC-MRI imaging to assess changes in blood perfusion and BBB permeability.
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