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Pandey A, Chandla A, Mekonnen M, Hovis GEA, Teton ZE, Patel KS, Everson RG, Wadehra M, Yang I. Safety and Efficacy of Laser Interstitial Thermal Therapy as Upfront Therapy in Primary Glioblastoma and IDH-Mutant Astrocytoma: A Meta-Analysis. Cancers (Basel) 2024; 16:2131. [PMID: 38893250 PMCID: PMC11171930 DOI: 10.3390/cancers16112131] [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: 05/01/2024] [Revised: 05/24/2024] [Accepted: 05/28/2024] [Indexed: 06/21/2024] Open
Abstract
Although primary studies have reported the safety and efficacy of LITT as a primary treatment in glioma, they are limited by sample sizes and institutional variation in stereotactic parameters such as temperature and laser power. The current literature has yet to provide pooled statistics on outcomes solely for primary brain tumors according to the 2021 WHO Classification of Tumors of the Central Nervous System (WHO CNS5). In the present study, we identify recent articles on primary CNS neoplasms treated with LITT without prior intervention, focusing on relationships with molecular profile, PFS, and OS. This meta-analysis includes the extraction of data from primary sources across four databases using the Covidence systematic review manager. The pooled data suggest LITT may be a safe primary management option with tumor ablation rates of 94.8% and 84.6% in IDH-wildtype glioblastoma multiforme (GBM) and IDH-mutant astrocytoma, respectively. For IDH-wildtype GBM, the pooled PFS and OS were 5.0 and 9.0 months, respectively. Similar to rates reported in the prior literature, the neurologic and non-neurologic complication rates for IDH-wildtype GBM were 10.3% and 4.8%, respectively. The neurologic and non-neurologic complication rates were somewhat higher in the IDH-mutant astrocytoma cohort at 33% and 8.3%, likely due to a smaller cohort size.
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Affiliation(s)
- Aryan Pandey
- Department of Neurosurgery, University of California Los Angeles (UCLA), Los Angeles, CA 90095, USA (M.M.)
| | - Anubhav Chandla
- Department of Neurosurgery, University of California Los Angeles (UCLA), Los Angeles, CA 90095, USA (M.M.)
| | - Mahlet Mekonnen
- Department of Neurosurgery, University of California Los Angeles (UCLA), Los Angeles, CA 90095, USA (M.M.)
| | - Gabrielle E. A. Hovis
- Department of Neurosurgery, University of California Los Angeles (UCLA), Los Angeles, CA 90095, USA (M.M.)
| | - Zoe E. Teton
- Department of Neurosurgery, University of California Los Angeles (UCLA), Los Angeles, CA 90095, USA (M.M.)
- Harbor-UCLA Medical Center, Torrance, CA 90502, USA
| | - Kunal S. Patel
- Department of Neurosurgery, University of California Los Angeles (UCLA), Los Angeles, CA 90095, USA (M.M.)
- Jonsson Comprehensive Cancer Center, Los Angeles, CA 90095, USA
| | - Richard G. Everson
- Department of Neurosurgery, University of California Los Angeles (UCLA), Los Angeles, CA 90095, USA (M.M.)
- Jonsson Comprehensive Cancer Center, Los Angeles, CA 90095, USA
- Department of Radiation Oncology, University of California Los Angeles (UCLA), Los Angeles, CA 90095, USA
- The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA 90502, USA
- Ronald Reagan UCLA Medical Center, Los Angeles, CA 90095, USA
| | - Madhuri Wadehra
- Jonsson Comprehensive Cancer Center, Los Angeles, CA 90095, USA
- Department of Pathology and Laboratory Medicine, University of California Los Angeles (UCLA), Los Angeles, CA 90095, USA
| | - Isaac Yang
- Department of Neurosurgery, University of California Los Angeles (UCLA), Los Angeles, CA 90095, USA (M.M.)
- Harbor-UCLA Medical Center, Torrance, CA 90502, USA
- Jonsson Comprehensive Cancer Center, Los Angeles, CA 90095, USA
- Department of Radiation Oncology, University of California Los Angeles (UCLA), Los Angeles, CA 90095, USA
- The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA 90502, USA
- Ronald Reagan UCLA Medical Center, Los Angeles, CA 90095, USA
- Department of Head and Neck Surgery, University of California Los Angeles (UCLA), Los Angeles, CA 90095, USA
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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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Viozzi I, Neutel C, Overduin C, Ter Laan M. Letter: Newly Diagnosed Adult Basal Ganglia Gliomas Treated With Laser Interstitial Thermal Therapy: A Comparative Cohort With Needle Biopsy. Oper Neurosurg (Hagerstown) 2023; 25:e188-e189. [PMID: 37387565 DOI: 10.1227/ons.0000000000000820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 05/11/2023] [Indexed: 07/01/2023] Open
Affiliation(s)
- Ilaria Viozzi
- Department of Neurosurgery, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Céline Neutel
- Department of Neurosurgery, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Christiaan Overduin
- Department of Radiology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Mark Ter Laan
- Department of Neurosurgery, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
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Merenzon MA, Patel NV, Komotar RJ, Ivan ME. In Reply: Newly Diagnosed Adult Basal Ganglia Gliomas Treated With Laser Interstitial Thermal Therapy: A Comparative Cohort With Needle Biopsy. Oper Neurosurg (Hagerstown) 2023; 25:e190-e191. [PMID: 37387567 DOI: 10.1227/ons.0000000000000821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 05/11/2023] [Indexed: 07/01/2023] Open
Affiliation(s)
- Martín A Merenzon
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Nitesh V Patel
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Ricardo J Komotar
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Michael E Ivan
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida, USA
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5
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Merenzon MA, Patel NV, Morell AA, Marcó Del Pont F, Moll JM, Komotar RJ, Ivan ME. Newly Diagnosed Adult Basal Ganglia Gliomas Treated With Laser Interstitial Thermal Therapy: A Comparative Cohort With Needle Biopsy. Oper Neurosurg (Hagerstown) 2023; 24:383-390. [PMID: 36701559 DOI: 10.1227/ons.0000000000000553] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 09/27/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Few cytoreductive surgical tools are available for newly diagnosed basal ganglia gliomas. Current reports showed high associated morbidity and mortality. Given their deep localization, laser interstitial thermal therapy (LITT) is still a rare indication. Moreover, few reports account for which of the available options have better outcomes. OBJECTIVE To retrospectively analyze our experience with LITT and compare its safety, feasibility, and efficacy with needle biopsy for the management of adult basal ganglia gliomas. METHODS Twenty-two patients with gliomas from the midline (e.g. thalamus and lenticular nucleus) managed with either LITT/biopsy or needle biopsy from 2015 to 2021 were included. Records regarding location, diagnosis, Karnofsky Performance Score, length of hospital stay, preoperative lesion and ablation volume, perioperative complications, and data of adjuvant treatment were collected. Overall survival was evaluated with Kaplan-Meier analysis. RESULTS Seven patients had LITT, and 15 underwent biopsy. The overall mean age was 60.9 years (25-82 years). The average tumor volume in the former was 16.99 cm 3 and 17.65 cm 3 in the latter. No postsurgical complications were found in the LITT group, and 1 patient had a postsurgical hemorrhage after biopsy. The mean overall survival was 20.28 ± 9.63 months in the LITT group, which was greater but not statistically significant than in the biopsy group (13.85 ± 4.48 months; P = .78). CONCLUSION Our results show that laser ablation may be both feasible and safe in adult basal ganglia gliomas. Given the lack of safe cytoreductive treatment options, LITT should be considered as a valid choice for these patients.
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Affiliation(s)
- Martín A Merenzon
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Nitesh V Patel
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Alexis A Morell
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Francisco Marcó Del Pont
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Joshua M Moll
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Ricardo J Komotar
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Michael E Ivan
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida, USA
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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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7
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Merenzon M, Levy AS, Bhatia S, Eatz T, Morell AA, Daggubati L, Berry K, Eichberg DG, Chandar J, Shah AH, Luther E, Lu VM, Komotar RJ, Ivan ME. Surgical Approaches to Thalamic Gliomas: A Systematic Review. World Neurosurg 2023; 171:25-34. [PMID: 36528315 DOI: 10.1016/j.wneu.2022.12.043] [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: 12/08/2022] [Accepted: 12/09/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Adult thalamic gliomas (ATGs) present a surgical challenge given their depth and proximity to eloquent brain regions. Choosing a surgical approach relies on different clinical variables such as anatomical location and size of the tumor. However, conclusive data regarding how these variables influence the balance between extent of resection and complications are lacking. We aim to systematically review the literature to describe the current surgical outcomes of ATG and to provide tools that may improve the decision-making process. METHODS Literature regarding the surgical management of ATG patients was reviewed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Four databases were queried and a description of clinical characteristics and survival analysis were performed. An individual patient data analysis was conducted when feasible. RESULTS A total of 462 patients were included from 13 studies. The mean age was 39.8 years with a median preoperative Karnofsky performance scale of 70. The lateral approaches were most frequently used (74.9%), followed by the interhemispheric (24.2%). Gross total and subtotal/partial resections were achieved in 81%, and 19% of all cases, respectively. New permanent neurological deficits were observed in 51/433 patients (11.8%). individual patient data was pooled from 5 studies (n = 71). In the multivariate analysis, tumors located within the posterior thalamus had worse median overall survival compared to anterior gliomas (14.5 vs. 27 months, P = 0.003). CONCLUSIONS Surgical resection of ATGs can increase survival but at the risk of operative morbidity. Knowing which factors impact survival may allow neurosurgeons to propose a more evidence-based treatment to their patients.
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Affiliation(s)
- Martín Merenzon
- Department of Neurological Surgery, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Adam S Levy
- Department of Neurological Surgery, University of Miami, Miller School of Medicine, Miami, Florida, USA.
| | - Shovan Bhatia
- Department of Neurological Surgery, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Tiffany Eatz
- Department of Neurological Surgery, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Alexis A Morell
- Department of Neurological Surgery, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Lekhaj Daggubati
- Department of Neurological Surgery, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Katherine Berry
- Department of Neurological Surgery, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Daniel G Eichberg
- Department of Neurological Surgery, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Jay Chandar
- Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, USA
| | - Ashish H Shah
- Department of Neurological Surgery, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Evan Luther
- Department of Neurological Surgery, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Victor M Lu
- Department of Neurological Surgery, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Ricardo J Komotar
- Department of Neurological Surgery, University of Miami, Miller School of Medicine, Miami, Florida, USA; Sylvester Cancer Center, University of Miami Health System, Miami, Florida, USA
| | - Michael E Ivan
- Department of Neurological Surgery, University of Miami, Miller School of Medicine, Miami, Florida, USA; Sylvester Cancer Center, University of Miami Health System, Miami, Florida, USA
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Ferroli P, Restelli F, Bertolini G, Monti E, Falco J, Bonomo G, Tramacere I, Pollo B, Calatozzolo C, Patanè M, Schiavolin S, Broggi M, Acerbi F, Erbetta A, Esposito S, Mazzapicchi E, La Corte E, Vetrano IG, Broggi G, Schiariti M. Are Thalamic Intrinsic Lesions Operable? No-Man's Land Revisited by the Analysis of a Large Retrospective, Mono-Institutional, Cohort. Cancers (Basel) 2023; 15:cancers15020361. [PMID: 36672311 PMCID: PMC9856718 DOI: 10.3390/cancers15020361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 12/30/2022] [Accepted: 01/04/2023] [Indexed: 01/09/2023] Open
Abstract
Thalamic gliomas represent a heterogeneous subset of deep-seated lesions for which surgical removal is advocated, although clear prognostic factors linked to advantages in performance status or overall survival are still lacking. We reviewed our Institutional Cancer Registry, identifying patients who underwent surgery for thalamic gliomas between 2006 and 2020. Associations between possible prognostic factors such as tumor volume, grade, the extent of resection and performance status (PS), and overall survival (OS) were evaluated using univariate and multivariate survival analyses. We found 56 patients: 31 underwent surgery, and 25 underwent biopsy. Compared to biopsy, surgery resulted positively associated with an increase in the OS (hazard ratio, HR, at multivariate analysis 0.30, 95% confidence interval, CI, 0.12-0.75). Considering the extent of resection (EOR), obtaining GTR/STR appeared to offer an OS advantage in high-grade gliomas (HGG) patients submitted to surgical resection if compared to biopsy, although we did not find statistical significance at multivariate analysis (HR 0.53, 95% CI 0.17-1.59). Patients with a stable 3-month KPS after surgery demonstrated to have a better prognosis in terms of OS if compared to biopsy (multivariate HR 0.17, 95% CI, 0.05-0.59). Age and histological grades were found to be prognostic factors for this condition (p = 0.04 and p = 0.004, respectively, chi-square test). Considering the entire cohort, p53 positivity (univariate HR 2.21, 95% CI 1.01-4.82) and ATRX positivity (univariate HR 2.69, 95% CI 0.92-7.83) resulted associated with a worse prognosis in terms of OS. In this work, we demonstrated that surgery aimed at tumor resection might offer a stronger survival advantage when a stable 3-month KPS after surgery is achieved.
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Affiliation(s)
- Paolo Ferroli
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Francesco Restelli
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
- Correspondence: ; Tel.: +39-02-2394-2309; Fax: +39-02-7063-5017
| | - Giacomo Bertolini
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Emanuele Monti
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Jacopo Falco
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Giulio Bonomo
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
- Department of Neurological Surgery, Policlinico “G. Rodolico–S. Marco”, University Hospital, 95123 Catania, Italy
| | - Irene Tramacere
- Department of Research and Clinical Development, Scientific Directorate, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Bianca Pollo
- Unit of Neuropathology, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Chiara Calatozzolo
- Unit of Neuropathology, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Monica Patanè
- Unit of Neuropathology, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Silvia Schiavolin
- Public Health and Disability Unit–Scientific Directorate, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Morgan Broggi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Francesco Acerbi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Alessandra Erbetta
- Unit of Neuroradiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Silvia Esposito
- Department of Paediatric Neuroscience, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Elio Mazzapicchi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Emanuele La Corte
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
- Department of Neurosurgery, Alma Mater Studiorum, University of Bologna, 40126 Bologna, Italy
| | - Ignazio Gaspare Vetrano
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, 20133 Milan, Italy
| | - Giovanni Broggi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
- IEN Foundation, 20100 Milan, Italy
| | - Marco Schiariti
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
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9
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Riviere-Cazaux C, Bhandarkar AR, Rahman M, Zheng CR, Bauman MMJ, Naylor RM, Van Gompel JJ, Zimmerman RS, White JJ, Parney IF, Chaichana KL, Miller KJ, Lehman VT, Kaufmann TJ, Burns TC. Outcomes and Principles of Patient Selection for Laser Interstitial Thermal Therapy for Metastatic Brain Tumor Management: A Multisite Institutional Case Series. World Neurosurg 2022; 165:e520-e531. [PMID: 35760326 DOI: 10.1016/j.wneu.2022.06.095] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 06/17/2022] [Accepted: 06/18/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Laser interstitial thermal therapy (LITT) is an emerging treatment modality for both primary brain tumors and metastases. We report initial outcomes after LITT for metastatic brain tumors across 3 sites at our institution and discuss potential strategies for optimal patient selection and outcomes. METHODS International Classification of Diseases, Ninth Revision and Tenth Revision codes were used to identify patients with malignant brain tumors treated via LITT across all 3 Mayo Clinic sites with at least 6 months follow-up. Local control was based on radiologic and clinical evidence. Overall survival was measured from time of receiving LITT until death or end of the study period. RESULTS Twenty-three patients were treated for progression of a single (n = 21) or multiple (n = 2) previously radiated metastatic lesions and/or radiation necrosis. Median age was 56 years (interquartile range, 47-66.5 years). LITT achieved local control of the lesion in most patients with metastatic tumors or radiation necrosis (n = 18; 81.8%) for the duration of follow-up. One patient did not have local control data available. Thirteen (56.5%) patients remained alive at the end of the study period. No other patients died of their treated disease during the study period; 5 of 10 deaths were attributable to central nervous system progression outside the treated lesion. Although median survival for this cohort has not yet been reached, the current median survival is 16 months (interquartile range, 12-48.5 months) after LITT for metastatic/radiation necrosis lesions. CONCLUSIONS LITT was associated with sustained local control in 81.8% of patients treated for radiographic progression of metastatic central nervous system disease.
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Affiliation(s)
- Cecile Riviere-Cazaux
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA; Mayo Clinic Alix School of Medicine, Rochester, Minnesota, USA
| | - Archis R Bhandarkar
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA; Mayo Clinic Alix School of Medicine, Rochester, Minnesota, USA
| | - Masum Rahman
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Clark R Zheng
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA; Mayo Clinic Alix School of Medicine, Rochester, Minnesota, USA
| | - Megan M J Bauman
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA; Mayo Clinic Alix School of Medicine, Rochester, Minnesota, USA
| | - Ryan M Naylor
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Jamie J Van Gompel
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Jaclyn J White
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Ian F Parney
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Kai J Miller
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Vance T Lehman
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Terry C Burns
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA.
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10
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Yousefi O, Sabahi M, Malcolm J, Adada B, Borghei-Razavi H. Laser Interstitial Thermal Therapy for Cavernous Malformations: A Systematic Review. Front Surg 2022; 9:887329. [PMID: 35647010 PMCID: PMC9136030 DOI: 10.3389/fsurg.2022.887329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 04/27/2022] [Indexed: 11/18/2022] Open
Abstract
Background Microsurgical resection of intracranial cavernous malformations (CM) is regarded as the standard treatment, but in recent years, there has been a trend toward minimally invasive procedures like ablation of such lesions by using laser interstitial thermal therapy (LITT). Methods A systematic search using keywords ‘laser interstitial thermal therapy’ OR ‘LITT’ AND ‘cavernoma’ OR ‘cavernous angiomas’ OR ‘cavernous malformations’ was conducted in MEDLINE (PubMed), Scopus, Embase, and Cochrane electronic bibliographic databases and studies reporting the outcome of LITT procedure on intracranial CM were included. The demographic data, symptoms of patients, location and size of the lesion, and surgical outcome were extracted from the articles. Result Six studies, reporting the outcome of 33 patients were included in this review. In 26 patients, CM was identified as the epileptogenic foci and in others, CM was the source of headache or focal neurological deficits. LITT led to a satisfactory outcome in all patients except for three who achieved improvement in symptoms after the open resection of the lesion. Most of the post-operative complications were transient and resolved at the time of the last follow up. Cyst formation at the previous ablated CM site was reported as the long-term complication of LITT in one case. Conclusion LITT can provide a comparable outcome to the open resection of CMs, by having less invasiveness, even in deep and eloquent area lesions, and complications that are often temporary and disappear gradually. However, technical issues, such as thermal monitoring during the procedure, are considered a challenge for this procedure in CMs. Further studies with a larger population are needed to report this method's long-term outcome and complications on CMs.
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Affiliation(s)
- Omid Yousefi
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammadmahdi Sabahi
- Neurosurgery Research Group (NRG), Student Research Committee, Hamadan University of Medical Sciences, Hamadan, Iran
| | - James Malcolm
- Department of Neurosurgery, Emory University, Atlanta, GA, United States
| | - Badih Adada
- Department of Neurological Surgery, Pauline Braathen Neurological Center, Cleveland Clinic Florida, Weston, FL, United States
| | - Hamid Borghei-Razavi
- Department of Neurological Surgery, Pauline Braathen Neurological Center, Cleveland Clinic Florida, Weston, FL, United States
- Correspondence: Hamid Borghei-Razavi
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11
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Johnson GW, Han RH, Smyth MD, Leuthardt EC, Kim AH. Laser Interstitial Thermal Therapy in Grade 2/3 IDH1/2 Mutant Gliomas: A Preliminary Report and Literature Review. Curr Oncol 2022; 29:2550-2563. [PMID: 35448183 PMCID: PMC9028957 DOI: 10.3390/curroncol29040209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 03/31/2022] [Accepted: 04/06/2022] [Indexed: 11/23/2022] Open
Abstract
Laser interstitial thermal therapy (LITT) has become an increasingly utilized alternative to surgical resection for the treatment of glioma in patients. However, treatment outcomes in isocitrate dehydrogenase 1 and 2 (IDH1/2) mutant glioma, specifically, have not been reported. The objective of this study was to characterize a single institution’s cohort of IDH1/2 mutant grade 2/3 glioma patients treated with LITT. We collected data on patient presentation, radiographic features, tumor molecular profile, complications, and outcomes. We calculated progression-free survival (PFS) and tested factors for significant association with longer PFS. Overall, 22.7% of our cohort experienced progression at a median follow up of 1.8 years. The three- and five-year estimates of PFS were 72.5% and 54.4%, respectively. This is the first study to characterize outcomes in patients with IDH1/2 mutant glioma after LITT. Our results suggest that LITT is an effective treatment option for IDH1/2 mutant glioma.
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Affiliation(s)
- Gabrielle W. Johnson
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO 63110, USA; (G.W.J.); (R.H.H.); (E.C.L.)
| | - Rowland H. Han
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO 63110, USA; (G.W.J.); (R.H.H.); (E.C.L.)
| | - Matthew D. Smyth
- Department of Neurosurgery, Johns Hopkins All Children’s Hospital, St. Petersburg, FL 33701, USA;
| | - Eric C. Leuthardt
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO 63110, USA; (G.W.J.); (R.H.H.); (E.C.L.)
- Brain Tumor Center, Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Albert H. Kim
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO 63110, USA; (G.W.J.); (R.H.H.); (E.C.L.)
- Brain Tumor Center, Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO 63110, USA
- Correspondence:
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12
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Baker C, Crevelt J, Whipple N, Bollo RJ, Cheshier S. Treatment of a symptomatic thalamic pilocytic astrocytoma with reservoir placement and laser interstitial thermal therapy: illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2022; 3:CASE21363. [PMID: 36209402 PMCID: PMC9379627 DOI: 10.3171/case21363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 09/02/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Treatment of pilocytic astrocytomas (PAs) in children can be challenging when they arise in deep midline structures because complete surgical resection may result in significant neurological injury. Laser interstitial thermal therapy (LITT) has provided an alternative treatment modality for lesions that may not be amenable to resection. However, many patients with PAs may be symptomatic from a compressive cyst associated with the PA, and LITT does not obviate the need for cystic decompression in these patients. OBSERVATIONS A 12-year-old male presented with left-sided weakness. Magnetic resonance imaging (MRI) revealed an enhancing mass with a large cyst involving the right thalamus and basal ganglia. The patient underwent a reservoir placement for cyst drainage and biopsy of the mass, revealing a pilocytic astrocytoma. He then underwent LITT followed by adjuvant chemotherapy. Sixteen months after LITT, follow-up MRI of the brain revealed no tumor growth. LESSONS This is the first case to describe reservoir placement to treat the cystic portion of a pilocytic astrocytoma followed by LITT and targeted chemotherapy. Reservoir placement reduced the cyst’s mass effect and resolved the patient’s symptoms, allowing for treatment options beyond resection.
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Affiliation(s)
- Cordell Baker
- Department of Neurosurgery, Intermountain Primary Children’s Hospital, University of Utah, Salt Lake City, Utah
| | - Jordan Crevelt
- School of Nursing, University of Utah, Salt Lake City, Utah; and
| | - Nicholas Whipple
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Primary Children’s Hospital, Salt Lake City, Utah
| | - Robert J. Bollo
- Department of Neurosurgery, Intermountain Primary Children’s Hospital, University of Utah, Salt Lake City, Utah
| | - Samuel Cheshier
- Department of Neurosurgery, Intermountain Primary Children’s Hospital, University of Utah, Salt Lake City, Utah
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13
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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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14
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Palmisciano P, El Ahmadieh TY, Haider AS, Bin Alamer O, Robertson FC, Plitt AR, Aoun SG, Yu K, Cohen-Gadol A, Moss NS, Patel TR, Sawaya R. Thalamic gliomas in adults: a systematic review of clinical characteristics, treatment strategies, and survival outcomes. J Neurooncol 2021; 155:215-224. [PMID: 34797525 DOI: 10.1007/s11060-021-03898-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 10/12/2021] [Indexed: 12/16/2022]
Abstract
PURPOSE Thalamic gliomas are rare neoplasms that pose significant surgical challenges. The literature is limited to single-institution retrospective case series. We systematically review the literature and describe the clinical characteristics, treatment strategies, and survival outcomes of adult thalamic gliomas. METHODS Relevant articles were identified on PubMed, Scopus, and Cochrane databases. Papers containing cases of adult thalamic gliomas with clinical outcome data were included. A comprehensive review of clinical characteristics and survival analysis was conducted. RESULTS We included 25 studies comprising 617 patients. The median age was 45 years (male = 58.6%). Glioblastoma was the most frequent histological type (47.2%), and 82 tumors were H3 K27M-mutant. Motor deficit was the most common presenting symptom (51.8%). Surgical resection was performed in 69.1% of cases while adjuvant chemotherapy and radiotherapy were administered in 56.3% and 72.6%, respectively. Other treatments included laser interstitial thermal therapy, which was performed in 15 patients (2.4%). The lesion laterality (P = 0.754) and the surgical approach (P = 0.111) did not correlate with overall survival. The median progression-free survival was 9 months, and the overall two-year survival rate was 19.7%. The two-year survival rates of low-grade and high-grade thalamic gliomas were 31.0% and 16.5%, respectively. H3 K27M-mutant gliomas showed worse overall survival (P = 0.017). CONCLUSION Adult thalamic gliomas are associated with poor survival. Complete surgical resection is associated with improved survival rates but is not always feasible. H3 K27M mutation is associated with worse survival and a more aggressive approach should be considered for mutant neoplasms.
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Affiliation(s)
- Paolo Palmisciano
- Department of Neurological Surgery, Trauma Center, Gamma Knife Center, Cannizzaro Hospital, Catania, Italy
| | - Tarek Y El Ahmadieh
- Department of Neurological Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA.
| | - Ali S Haider
- Texas A&M University College of Medicine, Houston, TX, USA
| | - Othman Bin Alamer
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Faith C Robertson
- Department of Neurological Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Aaron R Plitt
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Salah G Aoun
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Kenny Yu
- Department of Neurological Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA
| | - Aaron Cohen-Gadol
- Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Nelson S Moss
- Department of Neurological Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA
| | - Toral R Patel
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Raymond Sawaya
- Department of Neurological Surgery, MD Anderson Cancer Center, Houston, TX, USA
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15
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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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16
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Viozzi I, Guberinic A, Overduin CG, Rovers MM, ter Laan M. Laser Interstitial Thermal Therapy in Patients with Newly Diagnosed Glioblastoma: A Systematic Review. J Clin Med 2021; 10:jcm10020355. [PMID: 33477796 PMCID: PMC7832350 DOI: 10.3390/jcm10020355] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 01/12/2021] [Accepted: 01/15/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Laser interstitial thermal therapy (LITT) is a minimal invasive neurosurgical technique for the treatment of brain tumors. Results of LITT have been reported in a case series of patients with deep seated and/or recurrent glioblastoma or cerebral metastases. With this review we aim to summarize the currently available evidence regarding safety and effectiveness of LITT in patients with newly diagnosed glioblastoma (nGBM). METHODS A literature search was performed using electronic databases (PubMed and Embase). Papers were assessed for the methodological quality using the Risk Of Bias In Non- randomised Studies - of Interventions (ROBINS-I) tool, and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) was used to assess the quality of the evidence. RESULTS We identified 835 papers of which only 11 articles were eligible for our review. All papers suffered from serious or critical risk of bias, and the quality of evidence was graded as very low according to the GRADE criteria. None of the studies was randomized and reporting of confounders and other parameters was poor. Median overall survival (OS) ranged from 4.1 to 32 months and progression free survival (PFS) from 2 to 31 months. The mean complication rate was 33.7%. No quality of life or cost-effectiveness data were reported. CONCLUSIONS Due to the low quality of the studies, it is not possible to draw firm conclusions regarding the (cost) effectiveness of LITT in patients with newly diagnosed glioblastoma. The low quality of evidence shows the need for a well-designed prospective multicenter randomized controlled trial.
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Affiliation(s)
- Ilaria Viozzi
- Department of Neurosurgery, Radboud University Medical Center, Radboud Institute for Health Sciences, 6525 GA Nijmegen, The Netherlands; (I.V.); (A.G.)
| | - Alis Guberinic
- Department of Neurosurgery, Radboud University Medical Center, Radboud Institute for Health Sciences, 6525 GA Nijmegen, The Netherlands; (I.V.); (A.G.)
| | - Christiaan G. Overduin
- Department of Radiology, Radboud University Medical Center, Radboud Institute for Health Sciences, 6525 GA Nijmegen, The Netherlands;
| | - Maroeska M. Rovers
- Departments of Health Evidence and Operating Rooms, Radboud University Medical Center, Radboud Institute for Health Sciences, 6525 GA Nijmegen, The Netherlands;
| | - Mark ter Laan
- Department of Neurosurgery, Radboud University Medical Center, Radboud Institute for Health Sciences, 6525 GA Nijmegen, The Netherlands; (I.V.); (A.G.)
- Correspondence:
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17
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Grossman R. Commentary: Laser Interstitial Thermal Therapy in the Treatment of Thalamic Brain tumors: A Case Series. Oper Neurosurg (Hagerstown) 2020; 19:E555-E556. [PMID: 32970142 DOI: 10.1093/ons/opaa281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 07/02/2020] [Indexed: 11/14/2022] Open
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