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Valenzuela-Fuenzalida JJ, Moyano-Valarezo L, Silva-Bravo V, Milos-Brandenberg D, Orellana-Donoso M, Nova-Baeza P, Suazo-Santibáñez A, Rodríguez-Luengo M, Oyanedel-Amaro G, Sanchis-Gimeno J, Gutiérrez Espinoza H. Association between the Anatomical Location of Glioblastoma and Its Evaluation with Clinical Considerations: A Systematic Review and Meta-Analysis. J Clin Med 2024; 13:3460. [PMID: 38929990 PMCID: PMC11204640 DOI: 10.3390/jcm13123460] [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: 05/07/2024] [Revised: 06/04/2024] [Accepted: 06/07/2024] [Indexed: 06/28/2024] Open
Abstract
Background: Glioblastoma is a primary malignant brain tumor; it is aggressive with a high degree of malignancy and unfavorable prognosis and is the most common type of malignant brain tumor. Glioblastomas can be located in the brain, cerebellum, brainstem, and spinal cord, originating from glial cells, particularly astrocytes. Methods: The databases MEDLINE, Scopus, Web of Science, Google Scholar, and CINAHL were researched up to January 2024. Two authors independently performed the search, study selection, and data extraction. Methodological quality was evaluated with an assurance tool for anatomical studies (AQUA). The statistical mean, standard deviation, and difference of means calculated with the Student's t-test for presence between hemispheres and presence in the frontal and temporal lobes were analyzed. Results: A total of 123 studies met the established selection criteria, with a total of 6224 patients. In relation to the mean, GBM between hemispheres had a mean of 33.36 (SD 58.00) in the right hemisphere and a mean of 34.70 (SD 65.07) in the left hemisphere, due to the difference in averages between hemispheres. There were no statistically significant differences, p = 0.35. For the comparison between the presence of GBM in the frontal lobe and the temporal lobe, there was a mean in the frontal lobe of 23.23 (SD 40.03), while in the temporal lobe, the mean was 22.05 (SD 43.50), and for the difference in means between the frontal lobe and the temporal lobe, there was no statistically significant difference for the presence of GBM, p = 0.178. Conclusions: We believe that before a treatment, it will always be correct to know where the GBM is located and how it behaves clinically, in order to generate correct conservative or surgical treatment guidelines for each patient. We believe that more detailed studies are also needed to show why GBM is associated more with some regions than others, despite the brain structure being homologous to other regions in which GMB occurs less frequently, which is why knowing its predominant presence in brain regions is very important.
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Affiliation(s)
- Juan Jose Valenzuela-Fuenzalida
- Departamento de Ciencias Química y Biológicas, Facultad de Ciencias de la Salud, Universidad Bernardo O’Higgins, Santiago 8320000, Chile;
- Departament de Morfología, Facultad de Medicina, Universidad Andrés Bello, Santiago 8370146, Chile; (L.M.-V.); (V.S.-B.); (D.M.-B.); (P.N.-B.); (M.R.-L.)
| | - Laura Moyano-Valarezo
- Departament de Morfología, Facultad de Medicina, Universidad Andrés Bello, Santiago 8370146, Chile; (L.M.-V.); (V.S.-B.); (D.M.-B.); (P.N.-B.); (M.R.-L.)
| | - Vicente Silva-Bravo
- Departament de Morfología, Facultad de Medicina, Universidad Andrés Bello, Santiago 8370146, Chile; (L.M.-V.); (V.S.-B.); (D.M.-B.); (P.N.-B.); (M.R.-L.)
| | - Daniel Milos-Brandenberg
- Departament de Morfología, Facultad de Medicina, Universidad Andrés Bello, Santiago 8370146, Chile; (L.M.-V.); (V.S.-B.); (D.M.-B.); (P.N.-B.); (M.R.-L.)
- Escuela de Medicina, Facultad Ciencias de la Salud, Universidad del Alba, Santiago 8320000, Chile
| | - Mathias Orellana-Donoso
- Escuela de Medicina, Universidad Finis Terrae, Santiago 7501015, Chile;
- Department of Morphological Sciences, Faculty of Medicine and Science, Universidad San Sebastián, Santiago 8420524, Chile
| | - Pablo Nova-Baeza
- Departament de Morfología, Facultad de Medicina, Universidad Andrés Bello, Santiago 8370146, Chile; (L.M.-V.); (V.S.-B.); (D.M.-B.); (P.N.-B.); (M.R.-L.)
| | | | - Macarena Rodríguez-Luengo
- Departament de Morfología, Facultad de Medicina, Universidad Andrés Bello, Santiago 8370146, Chile; (L.M.-V.); (V.S.-B.); (D.M.-B.); (P.N.-B.); (M.R.-L.)
| | - Gustavo Oyanedel-Amaro
- Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Santiago 8910060, Chile;
| | - Juan Sanchis-Gimeno
- GIAVAL Research Group, Department of Anatomy and Human Embryology, Faculty of Medicine, University of Valencia, 46001 Valencia, Spain;
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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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Singh S, Bianchi L, Korganbayev S, Namakshenas P, Melnik R, Saccomandi P. Non-Fourier Bioheat Transfer Analysis in Brain Tissue During Interstitial Laser Ablation: Analysis of Multiple Influential Factors. Ann Biomed Eng 2024; 52:967-981. [PMID: 38236341 DOI: 10.1007/s10439-023-03433-5] [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: 07/07/2023] [Accepted: 12/22/2023] [Indexed: 01/19/2024]
Abstract
This work presents the dual-phase lag-based non-Fourier bioheat transfer model of brain tissue subjected to interstitial laser ablation. The finite element method has been utilized to predict the brain tissue's temperature distributions and ablation volumes. A sensitivity analysis has been conducted to quantify the effect of variations in the input laser power, treatment time, laser fiber diameter, laser wavelength, and non-Fourier phase lags. Notably, in this work, the temperature-dependent thermal properties of brain tissue have been considered. The developed model has been validated by comparing the temperature obtained from the numerical and ex vivo brain tissue during interstitial laser ablation. The ex vivo brain model has been further extended to in vivo settings by incorporating the blood perfusion effects. The results of the systematic analysis highlight the importance of considering temperature-dependent thermal properties of the brain tissue, non-Fourier behavior, and microvascular perfusion effects in the computational models for accurate predictions of the treatment outcomes during interstitial laser ablation, thereby minimizing the damage to surrounding healthy tissue. The developed model and parametric analysis reported in this study would assist in a more accurate and precise prediction of the temperature distribution, thus allowing to optimize the thermal dosage during laser therapy in the brain.
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Affiliation(s)
- Sundeep Singh
- Faculty of Sustainable Design Engineering, University of Prince Edward Island, Charlottetown, PE, C1A 4P3, Canada
| | - Leonardo Bianchi
- Department of Mechanical Engineering, Politecnico di Milano, 20156, Milan, Italy
| | - Sanzhar Korganbayev
- Department of Mechanical Engineering, Politecnico di Milano, 20156, Milan, Italy
| | - Pouya Namakshenas
- Department of Mechanical Engineering, Politecnico di Milano, 20156, Milan, Italy
| | - Roderick Melnik
- MS2Discovery Interdisciplinary Research Institute, Wilfrid Laurier University, Waterloo, ON, Canada
| | - Paola Saccomandi
- Department of Mechanical Engineering, Politecnico di Milano, 20156, Milan, Italy.
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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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Morello A, Bianconi A, Rizzo F, Bellomo J, Meyer AC, Garbossa D, Regli L, Cofano F. Laser Interstitial Thermotherapy (LITT) in Recurrent Glioblastoma: What Window of Opportunity for This Treatment? Technol Cancer Res Treat 2024; 23:15330338241249026. [PMID: 38693845 PMCID: PMC11067676 DOI: 10.1177/15330338241249026] [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: 09/24/2023] [Revised: 01/22/2024] [Accepted: 04/05/2024] [Indexed: 05/03/2024] Open
Abstract
Laser Interstitial Thermotherapy is a minimally invasive treatment option in neurosurgery for intracranial tumors, including recurrent gliomas. The technique employs the thermal ablation of target tissue to achieve tumor control with real-time monitoring of the extent by magnetic resonance thermometry, allowing targeted thermal injury to the lesion. Laser Interstitial Thermotherapy has gained interest as a treatment option for recurrent gliomas due to its minimally invasive nature, shorter recovery times, ability to be used even in patients with numerous comorbidities, and potential to provide local tumor control. It can be used as a standalone treatment or combined with other therapies, such as chemotherapy or radiation therapy. We describe the most recent updates regarding several studies and case reports that have evaluated the efficacy and safety of Laser Interstitial Thermotherapy for recurrent gliomas. These studies have reported different outcomes, with some demonstrating promising results in terms of tumor control and patient survival, while others have shown mixed outcomes. The success of Laser Interstitial Thermotherapy depends on various factors, including tumor characteristics, patient selection, and the experience of the surgical team, but the future direction of treatment of recurrent gliomas will include a combined approach, comprising Laser Interstitial Thermotherapy, particularly in deep-seated brain regions. Well-designed prospective studies will be needed to establish with certainty the role of Laser Interstitial Thermotherapy in the treatment of recurrent glioma.
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Affiliation(s)
- Alberto Morello
- Neurosurgery Unit, Department of Neuroscience “Rita Levi Montalcini”, “Città della Salute e della Scienza” University Hospital, University of Turin, Turin, Italy
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Andrea Bianconi
- Neurosurgery Unit, Department of Neuroscience “Rita Levi Montalcini”, “Città della Salute e della Scienza” University Hospital, University of Turin, Turin, Italy
| | - Francesca Rizzo
- Neurosurgery Unit, Department of Neuroscience “Rita Levi Montalcini”, “Città della Salute e della Scienza” University Hospital, University of Turin, Turin, Italy
| | - Jacopo Bellomo
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | | | - Diego Garbossa
- Neurosurgery Unit, Department of Neuroscience “Rita Levi Montalcini”, “Città della Salute e della Scienza” University Hospital, University of Turin, Turin, Italy
| | - Luca Regli
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Fabio Cofano
- Neurosurgery Unit, Department of Neuroscience “Rita Levi Montalcini”, “Città della Salute e della Scienza” University Hospital, University of Turin, Turin, Italy
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Terrapon APR, Krüger M, Hundsberger T, Neidert MC, Bozinov O. Laser Interstitial Thermal Therapy for Radionecrosis. Neurosurg Clin N Am 2023; 34:209-225. [PMID: 36906328 DOI: 10.1016/j.nec.2022.11.001] [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: 02/03/2023]
Abstract
Radiotherapy is widely used for brain tumors but can cause radiation necrosis (RN). Laser interstitial thermal therapy (LITT) is a relatively new therapeutic modality for RN and its impact on patient outcome is still not well understood. Based on a systematic literature search (n=33), the authors discuss the available evidence. Most studies found a positive safety/efficacy profile, as LITT may help to lengthen survival, prevent progression, taper steroids, and improve neurological symptoms while remaining safe. Prospective studies on this subject are needed and may result in LITT becoming an essential therapeutic option for the treatment of RN.
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Affiliation(s)
- Alexis Paul Romain Terrapon
- Department of Neurosurgery, Kantonsspital St. Gallen, Medical School St. Gallen, Rorschacher Strasse 95, St. Gallen 9007, Switzerland
| | - Marie Krüger
- Department of Neurosurgery, Kantonsspital St. Gallen, Medical School St. Gallen, Rorschacher Strasse 95, St. Gallen 9007, Switzerland; Unit of Functional Neurosurgery, Institute of Neurology and Neurosurgery, 33 Queen Square, London WC1N 3BG, UK; Department of Stereotactic and Functional Neurosurgery, University Medical Center Freiburg, Breisacher Strasse 64, Freiburg 79095, Germany
| | - Thomas Hundsberger
- Department of Neurology and of Oncology, Kantonsspital St. Gallen, Medical School St. Gallen, Rorschacher Strasse 95, St. Gallen 9007, Switzerland
| | - Marian Christoph Neidert
- Department of Neurosurgery, Kantonsspital St. Gallen, Medical School St. Gallen, Rorschacher Strasse 95, St. Gallen 9007, Switzerland
| | - Oliver Bozinov
- Department of Neurosurgery, Kantonsspital St. Gallen, Medical School St. Gallen, Rorschacher Strasse 95, St. Gallen 9007, Switzerland.
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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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Haskell-Mendoza AP, Srinivasan ES, Suarez AD, Fecci PE. Laser ablation of a sphenoid wing meningioma: A case report and review of the literature. Surg Neurol Int 2023; 14:138. [PMID: 37151451 PMCID: PMC10159314 DOI: 10.25259/sni_1000_2022] [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: 11/01/2022] [Accepted: 03/15/2023] [Indexed: 05/09/2023] Open
Abstract
Background Meningiomas are the most common primary central nervous system neoplasm in the United States. While the majority of meningiomas are benign, the World Health Organization (WHO) Grade I tumors, a not-insignificant proportion of tumors are in anatomically complex locations or demonstrate more aggressive phenotypes, presenting a challenge for local disease control with surgery and radiation. Laser interstitial thermal therapy (LITT) consists of stereotactic delivery of laser light for tumor ablation and is minimally invasive, requiring implantation of a laser fiber through a cranial burr hole. Herein, we demonstrate the first use of this technology in a progressive atypical sphenoid wing meningioma for a previously resected and irradiated tumor. Case Description A 47-year-old female was diagnosed with a left-sided atypical meningioma, the WHO 2, of the sphenoid wing following acute worsening of bitemporal headache and dizziness. Given neurovascular involvement, a subtotal resection was performed, followed by stereotactic radiosurgery. Following progression 9 months from resection, the patient elected to proceed with LITT. The patient's postoperative course was uncomplicated and she remains progression free at 24 months following LITT. Conclusion We present the first use of LITT for a sphenoid wing meningioma documented in the literature, which demonstrated enhanced disease control for a lesion that was refractory to both surgery and radiation. LITT could represent an additional option for local control of progressive meningiomas, even in locations that are challenging to access surgically. More evidence is needed regarding the technical nuances of LITT for lesions of the skull base.
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Affiliation(s)
- Aden P. Haskell-Mendoza
- Department of Neurosurgery, Duke University School of Medicine, Baltimore, MD, United States
| | - Ethan S. Srinivasan
- Department of Neurosurgery, Duke University School of Medicine, Baltimore, MD, United States
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Alexander D. Suarez
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, United States
| | - Peter E. Fecci
- Department of Neurosurgery, Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, Durham, North Carolina, United States
- Corresponding author: Peter E. Fecci, MD, PhD, Professor of Neurosurgery, Preston Robert Tisch Brain Tumor Center, Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA.
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10
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Hajtovic S, Sun J, Multani JS, Herrmann LL, Britton H, Gautreaux J, Tortolero L, Harrison G, Golfinos JG, Shepherd TM, Tanweer O, Placantonakis DG. Surgical cytoreduction of deep-seated high-grade glioma through tubular retractor. J Neurosurg 2022:1-12. [PMID: 36334293 DOI: 10.3171/2022.9.jns22842] [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: 04/14/2022] [Accepted: 09/26/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Maximal safe resection is the goal of surgical treatment for high-grade glioma (HGG). Deep-seated hemispheric gliomas present a surgical challenge due to safety concerns and previously were often considered inoperable. The authors hypothesized that use of tubular retractors would allow resection of deep-seated gliomas with an acceptable safety profile. The purpose of this study was to describe surgical outcomes and survival data after resection of deep-seated HGG with stereotactically placed tubular retractors, as well as to discuss the technical advances that enable such procedures. METHODS This is a retrospective review of 20 consecutive patients who underwent 22 resections of deep-seated hemispheric HGG with the Viewsite Brain Access System by a single surgeon. Patient demographics, survival, tumor characteristics, extent of resection (EOR), and neurological outcomes were recorded. Cannulation trajectories and planned resection volumes depended on the relative location of white matter tracts extracted from diffusion tractography. The surgical plans were designed on the Brainlab system and preoperatively visualized on the Surgical Theater virtual reality SNAP platform. Volumetric assessment of EOR was obtained on the Brainlab platform and confirmed by a board-certified neuroradiologist. RESULTS Twenty adult patients (18 with IDH-wild-type glioblastomas and 2 with IDH-mutant grade IV astrocytomas) and 22 surgeries were included in the study. The cohort included both newly diagnosed (n = 17; 77%) and recurrent (n = 5; 23%) tumors. Most tumors (64%) abutted the ventricular system. The average preoperative and postoperative tumor volumes measured 33.1 ± 5.3 cm3 and 15.2 ± 5.1 cm3, respectively. The median EOR was 93%. Surgical complications included 2 patients (10%) who developed entrapment of the temporal horn, necessitating placement of a ventriculoperitoneal shunt; 1 patient (5%) who suffered a wound infection and pulmonary embolus; and 1 patient (5%) who developed pneumonia. In 2 cases (9%) patients developed new permanent visual field deficits, and in 5 cases (23%) patients experienced worsening of preoperative deficits. Preoperative neurological or cognitive deficits remained the same in 9 cases (41%) and improved in 7 (32%). The median overall survival was 14.4 months in all patients (n = 20) and in the newly diagnosed IDH-wild-type glioblastoma group (n = 16). CONCLUSIONS Deep-seated HGGs, which are surgically challenging and frequently considered inoperable, are amenable to resection through tubular retractors, with an acceptable safety profile. Such cytoreductive surgery may allow these patients to experience an overall survival comparable to those with more superficial tumors.
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Affiliation(s)
- Sabastian Hajtovic
- Departments of1Neurosurgery and.,2The City University of New York (CUNY) School of Medicine, New York, New York
| | | | | | | | | | | | | | - Gillian Harrison
- Departments of1Neurosurgery and.,4Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | | | - Omar Tanweer
- 6Department of Neurosurgery, Baylor College of Medicine, Houston, Texas; and
| | - Dimitris G Placantonakis
- Departments of1Neurosurgery and.,7Laura and Isaac Perlmutter Cancer Center, NYU Grossman School of Medicine, New York, New York
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11
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Foo CY, Munir N, Kumaria A, Akhtar Q, Bullock CJ, Narayanan A, Fu RZ. Medical Device Advances in the Treatment of Glioblastoma. Cancers (Basel) 2022; 14:5341. [PMID: 36358762 PMCID: PMC9656148 DOI: 10.3390/cancers14215341] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 10/19/2022] [Accepted: 10/26/2022] [Indexed: 07/30/2023] Open
Abstract
Despite decades of research and the growing emergence of new treatment modalities, Glioblastoma (GBM) frustratingly remains an incurable brain cancer with largely stagnant 5-year survival outcomes of around 5%. Historically, a significant challenge has been the effective delivery of anti-cancer treatment. This review aims to summarize key innovations in the field of medical devices, developed either to improve the delivery of existing treatments, for example that of chemo-radiotherapy, or provide novel treatments using devices, such as sonodynamic therapy, thermotherapy and electric field therapy. It will highlight current as well as emerging device technologies, non-invasive versus invasive approaches, and by doing so provide a detailed summary of evidence from clinical studies and trials undertaken to date. Potential limitations and current challenges are discussed whilst also highlighting the exciting potential of this developing field. It is hoped that this review will serve as a useful primer for clinicians, scientists, and engineers in the field, united by a shared goal to translate medical device innovations to help improve treatment outcomes for patients with this devastating disease.
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Affiliation(s)
- Cher Ying Foo
- Imperial College School of Medicine, Imperial College London, Fulham Palace Rd., London W6 8RF, UK
| | - Nimrah Munir
- QV Bioelectronics Ltd., 1F70 Mereside, Alderley Park, Nether Alderley, Cheshire SK10 4TG, UK
| | - Ashwin Kumaria
- Department of Neurosurgery, Queen’s Medical Centre, Nottingham University Hospitals, Nottingham NG7 2UH, UK
| | - Qasim Akhtar
- QV Bioelectronics Ltd., 1F70 Mereside, Alderley Park, Nether Alderley, Cheshire SK10 4TG, UK
| | - Christopher J. Bullock
- QV Bioelectronics Ltd., 1F70 Mereside, Alderley Park, Nether Alderley, Cheshire SK10 4TG, UK
| | - Ashwin Narayanan
- QV Bioelectronics Ltd., 1F70 Mereside, Alderley Park, Nether Alderley, Cheshire SK10 4TG, UK
| | - Richard Z. Fu
- QV Bioelectronics Ltd., 1F70 Mereside, Alderley Park, Nether Alderley, Cheshire SK10 4TG, UK
- School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Michael, Smith Building, Dover St., Manchester M13 9PT, UK
- Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Salford Care Organisation, Northern Care Alliance NHS Foundation Trust, Salford Royal, Stott Lane, Salford M6 8HD, UK
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12
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Role of Laser Interstitial Thermal Therapy in the Management of Primary and Metastatic Brain Tumors. Curr Treat Options Oncol 2021; 22:108. [PMID: 34687357 DOI: 10.1007/s11864-021-00912-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2021] [Indexed: 10/20/2022]
Abstract
OPINION STATEMENT Laser interstitial thermal therapy (LITT) is a minimally invasive treatment option for brain tumors including glioblastoma, other primary central nervous system (CNS) neoplasms, metastases, and radiation necrosis. LITT employs a fiber optic coupled laser delivery probe stabilized via stereotaxis to deliver thermal energy that induces coagulative necrosis in tumors to achieve effective cytoreduction. LITT complements surgical resection, radiation treatment, tumor treating fields, and systemic therapy, especially in patients who are high risk for surgical resection due to tumor location in eloquent regions or poor functional status. These factors must be balanced with the increased rate of cerebral edema post LITT compared to surgical resection. LITT has also been shown to induce transient disruption of the blood-brain barrier (BBB), especially in the peritumoral region, which allows for enhanced CNS delivery of anti-neoplastic agents, thus greatly expanding the armamentarium against brain tumors to include highly effective anti-neoplastic agents that have poor BBB penetration. In addition, hyperthermia-induced immunogenic cell death is another secondary side effect of LITT that opens up immunotherapy as an attractive adjuvant treatment for brain tumors. Numerous large studies have demonstrated the safety and efficacy of LITT against various CNS tumors and as the literature continues to grow on this novel technique so will its indications.
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13
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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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14
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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] [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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15
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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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16
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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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17
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Abstract
The previous decade has seen an expansion in the use of laser interstitial thermal therapy (LITT) for a variety of pathologies. LITT has been used to treat both newly diagnosed and recurrent glioblastoma (GBM), especially in deep-seated, difficult-to-access lesions where open resection is otherwise infeasible or in patients who would not tolerate craniotomy. This review aims to describe the current state of the technology and operative technique, as well as summarize the outcomes data and future research regarding LITT as a treatment of GBM.
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Affiliation(s)
- Matthew M Grabowski
- Department of Neurosurgery, Rose Ella Burkhardt Brain Tumor & Neuro-Oncology Center, Cleveland Clinic, Cleveland, OH, USA
| | - Balint Otvos
- Department of Neurosurgery, Rose Ella Burkhardt Brain Tumor & Neuro-Oncology Center, Cleveland Clinic, Cleveland, OH, USA
| | - Alireza M Mohammadi
- Department of Neurological Surgery, Cleveland Clinic Lerner College of Medicine at CWRU, Rose Ella Burkhardt Brain Tumor & Neuro-Oncology Center, Cleveland Clinic, CA-51, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
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18
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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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19
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In situ vaccination with laser interstitial thermal therapy augments immunotherapy in malignant gliomas. J Neurooncol 2020; 151:85-92. [PMID: 32757094 DOI: 10.1007/s11060-020-03557-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 06/08/2020] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Laser interstitial thermal therapy (LITT) remains a promising advance in the treatment of primary central nervous system malignancies. As indications for its use continue to expand, there has been growing interest in its ability to induce prolonged blood brain barrier (BBB) permeability through hyperthermia, potentially increasing the effectiveness of current therapeutics including BBB-impermeant agents and immunotherapy platforms. METHODS In this review, we highlight the mechanism of hyperthermic BBB disruption and LITT-induced immunogenic cell death in preclinical models and humans. Additionally, we summarize ongoing clinical trials evaluating a combination approach of LITT and immunotherapy, which will likely serve as the basis for future neuro-oncologic treatment paradigms. RESULTS There is evidence to suggest a highly immunogenic response to laser interstitial thermal therapy through activation of both the innate and adaptive immune response. These mechanisms have been shown to potentiate standard methods of oncologic care. There are only a limited number of clinical trials are ongoing to evaluate the utility of LITT in combination with immunotherapy. CONCLUSION LITT continues to be studied as a possible technique to bridge the gap between exciting preclinical results and the limited successes seen in the field of neuro-oncology. Preliminary data suggests a substantial benefit for use of LITT as a combination therapy in several clinical trials. Further investigation is required to determine whether or not this treatment paradigm can translate into long-term durable results for primary intracranial malignancies.
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20
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Palejwala AH, O'Connor KP, Milton CK, Pelargos PE, Glenn CA, Bohnstedt BN, Algan O, Sughrue ME. Laser Interstitial Thermal Therapy for Metastatic Melanoma After Failed Radiation Therapy: A Case Series. Oper Neurosurg (Hagerstown) 2020; 19:126-133. [PMID: 32043143 DOI: 10.1093/ons/opaa012] [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: 06/20/2019] [Accepted: 12/15/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Laser interstitial thermal therapy (LITT) is a growing technology to treat a variety of brain lesions. It offers an alternative to treatment options, such as open craniotomy and stereotactic radiosurgery. OBJECTIVE To analyze our experience using LITT for metastatic melanoma. METHODS This is a retrospective chart review of the patients from our institution. Our case series involves 5 patients who had previously failed radiation treatment. RESULTS Our patients have low complication rates and short hospital stays. Both are considerably lower when compared to the literature for metastatic melanoma. CONCLUSION LITT is a safe therapy, with few complications and short hospital stays.
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Affiliation(s)
- Ali H Palejwala
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Kyle P O'Connor
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Camille K Milton
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Panayiotis E Pelargos
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Chad A Glenn
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Bradley N Bohnstedt
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Ozer Algan
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Michael E Sughrue
- Department of Neurosurgery, Prince of Wales Private Hospital, Randwick, Australia
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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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22
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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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23
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Freeman D, Guillaume D, Bell WR, Chen CC. Devascularization of a Hemorrhagic Pineocytoma by Laser Thermal Ablation Followed by Endoscopic Resection: A Proof-of-Principle Case Report. World Neurosurg 2020; 139:583-587. [PMID: 32360672 DOI: 10.1016/j.wneu.2020.04.125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 04/14/2020] [Accepted: 04/15/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Thermal coagulation is a central principle in surgery, particularly regarding hemostasis, as well as being an integral part of intracranial tumor removal. Traditionally, surgical hemostasis is achieved through application of unipolar or bipolar electrocautery. This method has been contemporized and specialized to treat intracranial tumors through a technique called stereotactic laser ablation (SLA), also known as laser interstitial thermal therapy. CASE DESCRIPTION In this article, we present this technique as an additional option in the treatment of difficult intracranial tumors. Specifically, we report here a highly vascular and hemorrhagic pineocytoma found in a fragile, elderly patient who underwent a novel combination of procedures: SLA mediated devascularization followed by resection via an endoscopic approach. CONCLUSIONS SLA-mediated thermal-coagulation is a potential strategy for minimizing hemorrhagic risks in brain tumor resection and may be used in conjunction with other approaches tailored to the patient and their disease.
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Affiliation(s)
- David Freeman
- Department of Neurosurgery, University of Minnesota Medical Center, Minneapolis, Minnesota, USA
| | - Daniel Guillaume
- Department of Neurosurgery, University of Minnesota Medical Center, Minneapolis, Minnesota, USA
| | - William Robert Bell
- Department of Pathology, University of Minnesota Medical Center, Minneapolis, Minnesota, USA
| | - Clark C Chen
- Department of Neurosurgery, University of Minnesota Medical Center, Minneapolis, Minnesota, USA.
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24
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Shao J, Radakovich NR, Grabowski M, Borghei-Razavi H, Knusel K, Joshi KC, Muhsen BA, Hwang L, Barnett GH, Mohammadi AM. Lessons Learned in Using Laser Interstitial Thermal Therapy for Treatment of Brain Tumors: A Case Series of 238 Patients from a Single Institution. World Neurosurg 2020; 139:e345-e354. [PMID: 32298824 DOI: 10.1016/j.wneu.2020.03.213] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 03/29/2020] [Accepted: 03/30/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Laser interstitial thermal therapy (LITT) is a novel, minimally invasive alternative to craniotomy, and as with any new technology, comes with a learning curve. OBJECTIVE We present our experience detailing the evolution of this technology in our practice in one of the largest patient cohorts to date regarding LITT in neuro-oncology. METHODS We reviewed 238 consecutive patients with brain tumor treated with LITT at our institution. Data on patient, surgery and tumor characteristics, and follow-up were collected. Patients were categorized into 2 cohorts: early (<2014, 100 patients) and recent (>2015, 138 patients). Median follow-up for the entire cohort was 8.4 months. RESULTS The indications for LITT included gliomas (70.2%), radiation necrosis (21.0%), and metastasis (8.8%). Patient demographics stayed consistent between the 2 cohorts, with the exception of age (early, 54.3; recent, 58.4; P = 0.04). Operative time (6.6 vs. 3.5; P < 0.001) and number of trajectories (53.1% vs. 77.9% with 1 trajectory; P < 0.001) also decreased in the recent cohort. There was a significant decrease in permanent motor deficits over time (15.5 vs. 4.4%; P = 0.005) and 30-day mortality (4.1% vs. 1.5%) also decreased (not statistically significant) in the recent cohort. In terms of clinical outcomes, poor preoperative Karnofsky Performance Status (≤70) were significantly correlated with increased permanent deficits (P = 0.001) and decreased overall survival (P < 0.001 for all time points). CONCLUSIONS We observed improvement in operative efficiency and permanent deficits over time and also patients with poor preoperative Karnofsky Performance Status achieved suboptimal outcomes with LITT. As many other treatment modalities, patient selection is important in this procedure.
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Affiliation(s)
- Jianning Shao
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA; Case Western School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Nathan R Radakovich
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA; Case Western School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Matthew Grabowski
- Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Hamid Borghei-Razavi
- Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Konrad Knusel
- Case Western School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Krishna C Joshi
- Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Baha'eddin A Muhsen
- Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA; Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio, USA
| | - Lee Hwang
- Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Gene H Barnett
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA; Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA; Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio, USA
| | - Alireza M Mohammadi
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA; Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA; Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio, USA.
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25
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Kamath AA, Friedman DD, Akbari SHA, Kim AH, Tao Y, Luo J, Leuthardt EC. Glioblastoma Treated With Magnetic Resonance Imaging-Guided Laser Interstitial Thermal Therapy: Safety, Efficacy, and Outcomes. Neurosurgery 2020; 84:836-843. [PMID: 30137606 PMCID: PMC6425465 DOI: 10.1093/neuros/nyy375] [Citation(s) in RCA: 81] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 07/19/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Despite the multitude of available treatments, glioblastoma (GBM) remains an aggressive and uniformly fatal tumor. Laser interstitial thermal therapy (LITT) is a novel, minimally invasive treatment that holds promise for treating patients with GBM who are not candidates for traditional open craniotomy. However, due to the recent introduction of LITT into clinical practice, large series that evaluate safety and long-term outcomes after LITT are lacking. OBJECTIVE To present our institution's series of over 50 GBM patients treated with LITT, with regard to safety, efficacy, and outcomes. METHODS We performed a retrospective descriptive study of patients with histologically proven GBM who underwent LITT. Data collected included demographics, tumor location and volume, tumor genetic markers, treatment volume, perioperative complications, and long-term follow-up data. RESULTS We performed 58 LITT treatments for GBM in 54 patients over 5.5 yr. Forty-one were recurrent tumors while 17 were frontline treatments. Forty GBMs were lobar in location, while 18 were in deep structures (thalamus, insula, corpus callosum). Average tumor volume was 12.5 ± 13.4 cm3. Average percentage of tumor treated with the yellow thermal damage threshold (TDT) line (dose equivalent of 43°C for 2 min) was 93.3% ± 10.6%, and with the blue TDT line (dose equivalent of 43°C for 10 min) was 88.0% ± 14.2%. There were 7 perioperative complications (12%) and 2 mortalities (3.4%). Median overall survival after LITT for the total cohort was 11.5 mo, and median progression-free survival 6.6 mo. CONCLUSION LITT appears to be a safe and effective treatment for GBM in properly selected patients.
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Affiliation(s)
- Ashwin A Kamath
- Departments of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Daniel D Friedman
- Departments of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - S Hassan A Akbari
- Departments of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Albert H Kim
- Departments of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri.,Department of Neurology, Washington University School of Medicine, St. Louis, Missouri.,Department of Developmental Biology, Washington University School of Medicine, St. Louis, Missouri.,Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri
| | - Yu Tao
- Department of Biostatistics, Washington University School of Medicine, St. Louis, Missouri
| | - Jinqin Luo
- Department of Biostatistics, Washington University School of Medicine, St. Louis, Missouri.,Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Eric C Leuthardt
- Departments of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri.,Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri.,Department of Biomedical Engineering, Washington University School of Medicine, St. Louis, Missouri.,Department of Mechanical Engineering and Materials Science, Washington University School of Medicine, St. Louis, Missouri.,Department of Neuroscience, Washington University School of Medicine, St. Louis, Missouri.,Center for Innovation in Neuroscience and Technology, Washington University School of Medicine, St. Louis, Missouri.,Brain Laser Center, Washington University School of Medicine, St. Louis, Missouri
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26
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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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27
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Beaumont TL, Mohammadi AM, Kim AH, Barnett GH, Leuthardt EC. Magnetic Resonance Imaging-Guided Laser Interstitial Thermal Therapy for Glioblastoma of the Corpus Callosum. Neurosurgery 2019; 83:556-565. [PMID: 29438526 DOI: 10.1093/neuros/nyx518] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Accepted: 01/29/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Glioblastoma of the corpus callosum is particularly difficult to treat, as the morbidity of surgical resection generally outweighs the potential survival benefit. Laser interstitial thermal therapy (LITT) is a safe and effective treatment option for difficult to access malignant gliomas of the thalamus and insula. OBJECTIVE To assess the safety and efficacy of LITT for the treatment of glioblastoma of the corpus callosum. METHODS We performed a multicenter retrospective analysis of prospectively collected data. The primary endpoint was the safety and efficacy of LITT as a treatment for glioblastoma of the corpus callosum. Secondary endpoints included tumor coverage at thermal damage thresholds, median survival, and change in Karnofsky Performance Scale score 1 mo after treatment. RESULTS The study included patients with de novo or recurrent glioblastoma of the corpus callosum (n = 15). Mean patient age was 54.7 yr. Mean pretreatment Karnofsky Performance Scale score was 80.7 and there was no significant difference between subgroups. Mean tumor volume was 18.7 cm3. Hemiparesis occurred in 26.6% of patients. Complications were more frequent in patients with tumors >15 cm3 (RR 6.1, P = .009) and were associated with a 32% decrease in survival postLITT. Median progression-free survival, survival postLITT, and overall survival were 3.4, 7.2, and 18.2 mo, respectively. CONCLUSION LITT is a safe and effective treatment for glioblastoma of the corpus callosum and provides survival benefit comparable to subtotal surgical resection with adjuvant chemoradiation. LITT-associated complications are related to tumor volume and can be nearly eliminated by limiting the procedure to tumors of 15 cm3 or less.
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Affiliation(s)
- Thomas L Beaumont
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Alireza M Mohammadi
- Department of Neurological Surgery, Cleveland Clinic, Cleveland, Ohio.,Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio
| | - Albert H Kim
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Gene H Barnett
- Department of Neurological Surgery, Cleveland Clinic, Cleveland, Ohio.,Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio
| | - Eric C Leuthardt
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri.,Center for Innovation in Neuroscience and Technology, Washington University School of Medicine, St. Louis, Missouri.,Department of Biomedical Engineering, Washington University, St. Louis, Missouri.,Department of Mechanical Engineering and Material Sciences, Washington University, St. Louis, Missouri
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28
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Alattar AA, Bartek J, Chiang VL, Mohammadi AM, Barnett GH, Sloan A, Chen CC. Stereotactic Laser Ablation as Treatment of Brain Metastases Recurring after Stereotactic Radiosurgery: A Systematic Literature Review. World Neurosurg 2019; 128:134-142. [DOI: 10.1016/j.wneu.2019.04.200] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 04/20/2019] [Accepted: 04/22/2019] [Indexed: 12/21/2022]
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29
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Baydin S, Gungor A, Holanda VM, Tanriover N, Danish SF. Microneuroanatomy of the Anterior Frontal Laser Trajectory to the Insula. World Neurosurg 2019; 132:e909-e921. [PMID: 31351206 DOI: 10.1016/j.wneu.2019.07.130] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Revised: 07/15/2019] [Accepted: 07/16/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Magnetic resonance imaging-guided laser interstitial thermal therapy (LITT) is an emerging minimally invasive procedure for the treatment of deep intracranial lesions. Insular lesions are challenging to treat because of the risk of damaging important surrounding structures. The precise knowledge of the neural structures that are at risk along the trajectory and during the ablation is essential to reduce associated complications. This study aims to describe the relevant anatomy of the anterior frontal LITT trajectory to the insular region by using sectional anatomy and fiber dissection technique. METHODS Three silicone-injected cadaveric heads were used to implant laser catheters bilaterally to the insular region by using a frameless stereotactic technique from a frontal approach. Sections were cut in both the oblique axial plane parallel to the trajectory and in the coronal plane. White matter fiber dissections were used to establish the tracts related to the laser trajectory from lateral to medial and medial to lateral. RESULTS Supraorbital regions were selected as entry points. After crossing the frontal bone, the track intersected the inferior frontal lobe. The catheter was illustrated reaching the insular region medial to the inferior fronto-occipital fasciculus and insular cortex, and superior to the uncinate fasciculus. The uncinate fasciculus, extreme capsule, claustrum, external capsule, and putamen were traversed, preserving the major vascular structures. CONCLUSIONS Independent of the insular area treated, an understanding of the neuroanatomy related to the anterior frontal laser trajectory is essential to improve the ability to perform LITT of this challenging region.
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Affiliation(s)
- Serhat Baydin
- Department of Neurosurgery, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey.
| | - Abuzer Gungor
- Department of Neurosurgery, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Vanessa M Holanda
- Center of Neurology and Neurosurgery Associates (NeuroCENNA), Beneficência Portuguesa of São Paulo Hospital, São Paulo-SP, Brazil
| | - Necmettin Tanriover
- Department of Neurosurgery, Istanbul University Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Shabbar F Danish
- Department of Neurosurgery, Rutgers-RWJ Medical School, New Brunswick, New Jersey, USA
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30
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Marenco-Hillembrand L, Alvarado-Estrada K, Chaichana KL. Contemporary Surgical Management of Deep-Seated Metastatic Brain Tumors Using Minimally Invasive Approaches. Front Oncol 2018; 8:558. [PMID: 30547010 PMCID: PMC6279910 DOI: 10.3389/fonc.2018.00558] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 11/09/2018] [Indexed: 12/04/2022] Open
Abstract
A subset of metastatic brain tumors occurs in deep-seated locations. Accessing and resecting these lesions can be associated with significant morbidity because it involves large craniotomies, extensive white matter dissection, prolonged retraction, and risk of inadvertent tissue injury. As a result, only palliative treatment options are typically offered for these lesions including observation, needle biopsies, and/or radiation therapy. With the development of new surgical tools and techniques, minimally invasive techniques have allowed for the treatment of these lesions previously associated with significant morbidity. These minimally invasive techniques include laser interstitial thermal therapy and channel-based resections.
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31
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Salehi A, Kamath AA, Leuthardt EC, Kim AH. Management of Intracranial Metastatic Disease With Laser Interstitial Thermal Therapy. Front Oncol 2018; 8:499. [PMID: 30430083 PMCID: PMC6220072 DOI: 10.3389/fonc.2018.00499] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 10/15/2018] [Indexed: 11/13/2022] Open
Abstract
Treatment approaches for metastatic brain tumors continue to evolve, with increasing recent emphasis on focal therapies whenever possible. MRI-guided Laser Interstitial Thermal Therapy (LITT) is a minimally invasive surgical option that has broadened the capability of the neurosurgeon in treating difficult-to-treat intracranial lesions. This technology uses image-guided delivery of laser to the target lesion to generate heat and thereby ablate pathological tissue and has expanded the neurosurgical armamentarium for surgical treatment of brain metastases. In this study, we describe the indications for LITT in the management of intracranial metastatic disease and report our institutional experience with LITT.
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Affiliation(s)
- Afshin Salehi
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, United States
| | - Ashwin A Kamath
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, United States
| | - Eric C Leuthardt
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, United States
| | - Albert H Kim
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, United States
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32
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The Safety of Bevacizumab Administered Shortly after Laser Interstitial Thermal Therapy in Glioblastoma: A Case Series. World Neurosurg 2018; 117:e588-e594. [DOI: 10.1016/j.wneu.2018.06.092] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Revised: 06/11/2018] [Accepted: 06/12/2018] [Indexed: 11/18/2022]
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33
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Rennert RC, Khan U, Tatter SB, Field M, Toyota B, Fecci PE, Judy K, Mohammadi AM, Landazuri P, Sloan A, Leuthardt E, Chen CC. Patterns of Clinical Use of Stereotactic Laser Ablation: Analysis of a Multicenter Prospective Registry. World Neurosurg 2018; 116:e566-e570. [DOI: 10.1016/j.wneu.2018.05.039] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 05/04/2018] [Accepted: 05/05/2018] [Indexed: 11/30/2022]
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34
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Liu W, Qdaisat A, Yeung J, Lopez G, Weinberg J, Zhou S, Cohen L, Bruera E, Yeung SCJ. The Association Between Common Clinical Characteristics and Postoperative Morbidity and Overall Survival in Patients with Glioblastoma. Oncologist 2018; 24:529-536. [PMID: 30049883 DOI: 10.1634/theoncologist.2018-0056] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 05/08/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The impact of noncancerous factors on the morbidity and mortality of glioblastoma multiforme (GBM) has not been well studied. Using a large surgical cohort, we examined the association between multiple clinical characteristics and postoperative morbidities and survival in patients with GBM. MATERIALS AND METHODS The study included 404 consecutive GBM patients who underwent initial tumor resection at MD Anderson Cancer Center between January 1, 2010, and December 31, 2014. Data about clinical characteristics, treatments, and postoperative complications were collected. The associations between clinical parameters and postoperative complications and survival were analyzed. RESULTS Charlson Comorbidity Index was positively related to a higher incidence of postoperative total (odds ratio [OR] = 1.20; p = .002) and neurological (OR = 1.18; p = .011) complications. Preoperative systolic blood pressure (SBp) over 140 mmHg was associated with a higher incidence of postoperative intracranial hemorrhage (OR = 4.42; p = .039) and longer hospital stay (OR = 2.48; p = .015). Greater postoperative fluctuation of SBp (OR = 1.14; p = .025) and blood glucose (mmol/L; OR = 1.48; p = .023) were related to a higher incidence of neurological complications, whereas higher postoperative blood glucose (OR = 0.64; p < .001) was related to a lower incidence. Long-term lower SBp (<124 mmHg; hazard ratio [HR] = 1.47; p = .010) and higher blood glucose (HR = 1.12; p < .001) were associated with shorter survival. Long-term serum albumin level (g/dL; HR = 0.32; p < .001) was positively associated with survival. CONCLUSION Short-term SBp and blood glucose levels and fluctuations are associated with postoperative complications in GBM patients. Their long-term optimization may impact survival of these patients. Future clinical trials are needed to confirm the benefit of optimizing medical comorbidities on GBM patients' outcomes. IMPLICATIONS FOR PRACTICE Glioblastoma multiforme (GBM) is one of the most feared cancer diagnoses because of its limited survival and treatment. This study revealed significant associations of noncancerous factors on the morbidity and mortality of GBM. The complexity of medical comorbidities, as well as short-term postoperative levels and fluctuations of blood pressure and blood glucose, was associated with postoperative complications, but not overall survival. However, long-term levels of these common clinical parameters were significantly associated with survival. Optimization of medical conditions may be critical for reducing the morbidity and mortality of GBM patients. Future clinical trials are needed to validate the observed associations in an independent cohort.
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Affiliation(s)
- Wenli Liu
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Aiham Qdaisat
- Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jason Yeung
- Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Gabriel Lopez
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jeffrey Weinberg
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Shouhao Zhou
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Lorenzo Cohen
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Eduardo Bruera
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sai-Ching J Yeung
- Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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35
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Shah AH, Burks JD, Buttrick SS, Debs L, Ivan ME, Komotar RJ. Laser Interstitial Thermal Therapy as a Primary Treatment for Deep Inaccessible Gliomas. Neurosurgery 2018; 84:768-777. [DOI: 10.1093/neuros/nyy238] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 05/11/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ashish H Shah
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Joshua D Burks
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Simon S Buttrick
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Luca Debs
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Michael E Ivan
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Ricardo J Komotar
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida
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36
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Maraka S, Asmaro K, Walbert T, Lee I. Cerebral edema induced by laser interstitial thermal therapy and radiotherapy in close succession in patients with brain tumor. Lasers Surg Med 2018; 50:917-923. [DOI: 10.1002/lsm.22946] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2018] [Indexed: 02/03/2023]
Affiliation(s)
- Stefania Maraka
- Department of Neurology; Henry Ford Hospital; Detroit Michigan 48202
- MD Anderson Cancer Center, Department of Neuro-oncology; The University of Texas; Houston Texas 77030
| | - Karam Asmaro
- Hermelin Brain Tumor Center, Department of Neurosurgery; Henry Ford Hospital; Detroit Michigan 48202
| | - Tobias Walbert
- Department of Neurology; Henry Ford Hospital; Detroit Michigan 48202
- Hermelin Brain Tumor Center, Department of Neurosurgery; Henry Ford Hospital; Detroit Michigan 48202
| | - Ian Lee
- Hermelin Brain Tumor Center, Department of Neurosurgery; Henry Ford Hospital; Detroit Michigan 48202
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37
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Wright JM, Staudt MD, Alonso A, Miller JP, Sloan AE. A novel use of the NeuroBlate SideFire probe for minimally invasive disconnection of a hypothalamic hamartoma in a child with gelastic seizures. J Neurosurg Pediatr 2018; 21:302-307. [PMID: 29328005 DOI: 10.3171/2017.9.peds1747] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The authors describe the case of a 22-month-old boy who presented with gelastic seizures and developmental delay. Magnetic resonance imaging and video-electroencephalography monitoring revealed a primarily intraventricular hypothalamic hamartoma and gelastic seizures occurring 20-30 times daily. The patient was treated with various regimens of antiepileptic medications for 16 months, but the seizures remained medically intractable. At 3 years of age, he underwent stereotactic laser ablation with an aim of disconnection of the lesion. The procedure was performed with the NeuroBlate SideFire probe. To the authors' knowledge, this is the first reported use of this technology for this procedure and serves as proof of concept. There were no perioperative complications, and 2 years postprocedure, the patient remains seizure free with marked behavioral and cognitive improvements.
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Affiliation(s)
- James M Wright
- 1Department of Neurological Surgery, University Hospitals, Case Western Reserve University.,3Case Western Reserve University School of Medicine, Cleveland, Ohio; and
| | - Michael D Staudt
- 1Department of Neurological Surgery, University Hospitals, Case Western Reserve University.,4Department of Clinical Neurological Sciences, London Health Science Centre, Western University, London, Ontario, Canada
| | - Andrea Alonso
- 3Case Western Reserve University School of Medicine, Cleveland, Ohio; and
| | - Jonathan P Miller
- 1Department of Neurological Surgery, University Hospitals, Case Western Reserve University.,3Case Western Reserve University School of Medicine, Cleveland, Ohio; and
| | - Andrew E Sloan
- 1Department of Neurological Surgery, University Hospitals, Case Western Reserve University.,3Case Western Reserve University School of Medicine, Cleveland, Ohio; and
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Ferguson SD, Wagner KM, Prabhu SS, McAleer MF, McCutcheon IE, Sawaya R. Neurosurgical management of brain metastases. Clin Exp Metastasis 2017; 34:377-389. [PMID: 28965270 DOI: 10.1007/s10585-017-9860-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 09/05/2017] [Indexed: 12/26/2022]
Abstract
Brain metastases present a significant public health issue, affecting more than 100,000 patients per year in the U.S. and result in significant morbidity. Brain metastases can occur in a variety of clinical situations ranging from multiple brain metastases with uncontrolled systemic disease to a solitary metastasis in the setting of controlled systemic disease. Additionally, advances in genomics have broadened the opportunities for targeted treatment options and potentially more durable systemic responses. As such, the treatment of brain metastases is now more tailored and multimodal, involving systemic, radiation, and surgical therapies, often in combination. This review discusses the historical and current role of neurosurgical techniques in the treatment of brain metastases.
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Affiliation(s)
- Sherise D Ferguson
- Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, 1400 Holcombe Blvd, Houston, TX, 77030, USA.
| | - Kathryn M Wagner
- Department of Neurosurgery, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX, 77030, USA
| | - Sujit S Prabhu
- Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, 1400 Holcombe Blvd, Houston, TX, 77030, USA
| | - Mary F McAleer
- Department of Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Ian E McCutcheon
- Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, 1400 Holcombe Blvd, Houston, TX, 77030, USA
| | - Raymond Sawaya
- Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, 1400 Holcombe Blvd, Houston, TX, 77030, USA
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Bianco J, Bastiancich C, Jankovski A, des Rieux A, Préat V, Danhier F. On glioblastoma and the search for a cure: where do we stand? Cell Mol Life Sci 2017; 74:2451-2466. [PMID: 28210785 PMCID: PMC11107640 DOI: 10.1007/s00018-017-2483-3] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 01/30/2017] [Indexed: 01/25/2023]
Abstract
Although brain tumours have been documented and recorded since the nineteenth century, 2016 marked 90 years since Percival Bailey and Harvey Cushing coined the term "glioblastoma multiforme". Since that time, although extensive developments in diagnosis and treatment have been made, relatively little improvement on prognosis has been achieved. The resilience of GBM thus makes treating this tumour one of the biggest challenges currently faced by neuro-oncology. Aggressive and robust development, coupled with difficulties of complete resection, drug delivery and therapeutic resistance to treatment are some of the main issues that this nemesis presents today. Current treatments are far from satisfactory with poor prognosis, and focus on palliative management rather than curative intervention. However, therapeutic research leading to developments in novel treatment stratagems show promise in combating this disease. Here we present a review on GBM, looking at the history and advances which have shaped neurosurgery over the last century that cumulate to the present day management of GBM, while also exploring future perspectives in treatment options that could lead to new treatments on the road to a cure.
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Affiliation(s)
- John Bianco
- Louvain Drug Research Institute, Advanced Drug Delivery and Biomaterials, Université catholique de Louvain, Avenue Mounier 73, bte B1 73.12, 1200, Brussels, Belgium.
| | - Chiara Bastiancich
- Louvain Drug Research Institute, Advanced Drug Delivery and Biomaterials, Université catholique de Louvain, Avenue Mounier 73, bte B1 73.12, 1200, Brussels, Belgium
| | - Aleksander Jankovski
- Institute of Neuroscience, Université catholique de Louvain, Avenue Hippocrate B1.54.10, 1200, Brussels, Belgium
- Department of Neurosurgery, CHU UCL Namur, Avenue G. Thérasse 1, 5530, Yvoir, Belgium
| | - Anne des Rieux
- Louvain Drug Research Institute, Advanced Drug Delivery and Biomaterials, Université catholique de Louvain, Avenue Mounier 73, bte B1 73.12, 1200, Brussels, Belgium
- Institute of Condensed Matter and Nanosciences, Université catholique de Louvain, 1348, Louvain-la-Neuve, Belgium
| | - Véronique Préat
- Louvain Drug Research Institute, Advanced Drug Delivery and Biomaterials, Université catholique de Louvain, Avenue Mounier 73, bte B1 73.12, 1200, Brussels, Belgium.
| | - Fabienne Danhier
- Louvain Drug Research Institute, Advanced Drug Delivery and Biomaterials, Université catholique de Louvain, Avenue Mounier 73, bte B1 73.12, 1200, Brussels, Belgium
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