Laser interstitial thermal therapy (LITT) for intracranial lesions: a single-institutional series, outcomes, and review of the literature

Subependymal giant cell astrocytoma (SEGA) is a rare tumor occurring almost exclusively in patients with tuberous sclerosis complex. Although open resection remains the standard therapy, complication rates remain high. To minimize morbidity, less invasive approaches, such as endoscope-assisted resection, radiosurgery, and chemotherapy with mTOR pathway inhibitors, are also used to treat these lesions. Laser interstitial thermal therapy (LITT) is a relatively new modality that is increasingly used to treat a variety of intracranial lesions. In this report, the authors describe two pediatric cases of SEGA that were treated with LITT. In both patients the lesion responded well to this treatment modality, with tumor shrinkage observed on follow-up MRI. These cases highlight the potential of LITT to serve as a viable minimally invasive therapeutic approach to the management of SEGAs in the pediatric population.

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Journal Club: Magnetic Resonance Imaging-Guided Focused Laser Interstitial Thermal Therapy for Intracranial Lesions

Neurosurgery ◽

10.1227/neu.0000000000000313 ◽

2014 ◽

Vol 74 (5) ◽

pp. 562-564

Author(s):

Pratik Rohatgi ◽

Brian Anderson ◽

Einar Bogason ◽

Nicholas Brandmeir ◽

Ephraim Church ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Journal Club ◽

Thermal Therapy ◽

Resonance Imaging ◽

Laser Interstitial Thermal Therapy ◽

Intracranial Lesions

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Laser Interstitial Thermal Therapy Technology, Physics of Magnetic Resonance Imaging Thermometry, and Technical Considerations for Proper Catheter Placement During Magnetic Resonance Imaging–Guided Laser Interstitial Thermal Therapy

Neurosurgery ◽

10.1227/neu.0000000000001440 ◽

2016 ◽

Vol 79 (suppl_1) ◽

pp. S8-S16 ◽

Cited By ~ 22

Author(s):

Nitesh V. Patel ◽

Matthew Mian ◽

R. Jason Stafford ◽

Brian V. Nahed ◽

Jon T. Willie ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Treatment Algorithm ◽

Thermal Therapy ◽

Catheter Placement ◽

Clear Understanding ◽

Resonance Imaging ◽

Laser Interstitial Thermal Therapy ◽

Basic Physics ◽

Intracranial Lesions

Abstract Laser-induced thermal therapy has become a powerful tool in the neurosurgical armamentarium. The physics of laser therapy are complex, but a sound understanding of this topic is clinically relevant, as many centers have incorporated it into their treatment algorithm, and educated patients are demanding consideration of its use for their disease. Laser ablation has been used for a wide array of intracranial lesions. Laser catheter placement is guided by stereotactic planning; however, as the procedure has popularized, the number of ways in which the catheter can be inserted has also increased. There are many technical nuances for laser placement, and, to date, there is not a clear understanding of whether any one technique is better than the other. In this review, we describe the basic physics of magnetic resonance–guided laser-induced thermal therapy and describe the several common techniques for accurate Visualase laser catheter placement in a stepwise fashion.

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Magnetic Resonance Imaging-Guided Focused Laser Interstitial Thermal Therapy for Intracranial Lesions

Neurosurgery ◽

10.1227/neu.0000000000000144 ◽

2013 ◽

Vol 73 (6) ◽

pp. 1007-1017 ◽

Cited By ~ 117

Author(s):

Ammar H. Hawasli ◽

Swapnil Bagade ◽

Joshua S. Shimony ◽

Michelle Miller-Thomas ◽

Eric C. Leuthardt

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Treatment Option ◽

Progression Free Survival ◽

Thermal Therapy ◽

Seizure Freedom ◽

Resonance Imaging ◽

Laser Interstitial Thermal Therapy ◽

Imaging Characteristics ◽

Intracranial Lesions

Abstract BACKGROUND: Surgical treatments for deep-seated intracranial lesions have been limited by morbidities associated with resection. Real-time magnetic resonance imaging–guided focused laser interstitial thermal therapy (LITT) offers a minimally invasive surgical treatment option for such lesions. OBJECTIVE: To review treatments and results of patients treated with LITT for intracranial lesions at Washington University School of Medicine. METHODS: In a review of 17 prospectively recruited LITT patients (34–78 years of age; mean, 59 years), we report demographics, treatment details, postoperative imaging characteristics, and peri- and postoperative clinical courses. RESULTS: Targets included 11 gliomas, 5 brain metastases, and 1 epilepsy focus. Lesions were lobar (n = 8), thalamic/basal ganglia (n = 5), insular (n = 3), and corpus callosum (n = 1). Mean target volume was 11.6 cm3, and LITT produced 93% target ablation. Patients with superficial lesions had shorter intensive care unit stays. Ten patients experienced no perioperative morbidities. Morbidities included transient aphasia, hemiparesis, hyponatremia, deep venous thrombosis, and fatal meningitis. Postoperative magnetic resonance imaging showed blood products within the lesion surrounded by new thin uniform rim of contrast enhancement and diffusion restriction. In conjunction with other therapies, LITT targets often showed stable or reduced local disease. Epilepsy focus LITT produced seizure freedom at 8 months. Preliminary overall median progression-free survival and survival from LITT in tumor patients were 7.6 and 10.9 months, respectively. However, this small cohort has not been followed for a sufficient length of time, necessitating future outcomes studies. CONCLUSION: Early peri- and postoperative clinical data demonstrate that LITT is a safe and viable ablative treatment option for intracranial lesions, and may be considered for select patients.

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Response to Journal Club: Magnetic Resonance Imaging-Guided Focused Laser Interstitial Thermal Therapy for Intracranial Lesions

Neurosurgery ◽

10.1227/neu.0000000000000314 ◽

2014 ◽

Vol 74 (5) ◽

pp. 565-565 ◽

Cited By ~ 1

Author(s):

Eric C. Leuthardt ◽

Ammar H. Hawasli

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Journal Club ◽

Thermal Therapy ◽

Resonance Imaging ◽

Laser Interstitial Thermal Therapy ◽

Intracranial Lesions

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Laser interstitial thermal therapy for brain metastases

Neuro-Oncology Advances ◽

10.1093/noajnl/vdab128 ◽

2021 ◽

Vol 3 (Supplement_5) ◽

pp. v16-v25

Author(s):

Ethan S Srinivasan ◽

Matthew M Grabowski ◽

Brian V Nahed ◽

Gene H Barnett ◽

Peter E Fecci

Keyword(s):

Metastatic Disease ◽

Thermal Ablation ◽

Radiation Necrosis ◽

Recovery Period ◽

Current Data ◽

Thermal Therapy ◽

Invasive Treatment ◽

Future Directions ◽

Laser Interstitial Thermal Therapy ◽

Intracranial Lesions

Abstract Laser interstitial thermal therapy (LITT) is a minimally invasive treatment for intracranial lesions entailing thermal ablation via a stereotactically placed laser probe. In metastatic disease, it has shown the most promise in the treatment of radiographically progressive lesions after initial stereotactic radiosurgery, whether due to recurrent metastatic disease or radiation necrosis. LITT has been demonstrated to provide clinical benefit in both cases, as discussed in the review below. With its minimal surgical footprint and short recovery period, LITT is further advantaged for patients who are otherwise high-risk surgical candidates or with lesions in difficult to access locations. Exploration of the current data on its use in metastatic disease will allow for a better understanding of the indications, benefits, and future directions of LITT for these patients.

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Spinal laser interstitial thermal therapy: single-center experience and outcomes in the first 120 cases

Journal of Neurosurgery Spine ◽

10.3171/2020.7.spine20661 ◽

2020 ◽

pp. 1-10

Author(s):

Dhiego C. A. Bastos ◽

Rafael A. Vega ◽

Jeffrey I. Traylor ◽

Amol J. Ghia ◽

Jing Li ◽

...

Keyword(s):

Local Recurrence ◽

Local Control ◽

Thoracic Spine ◽

Adjuvant Radiotherapy ◽

Neurological Complications ◽

Thermal Therapy ◽

External Beam Radiation ◽

Beam Radiation ◽

Laser Interstitial Thermal Therapy ◽

Hazard Ratios

OBJECTIVEThe objective of this study was to present the results of a consecutive series of 120 cases treated with spinal laser interstitial thermal therapy (sLITT) to manage epidural spinal cord compression (ESCC) from metastatic tumors.METHODSThe electronic records of patients treated from 2013 to 2019 were analyzed retrospectively. Data collected included demographic, pathology, clinical, operative, and imaging findings; degree of epidural compression before and after sLITT; length of hospital stay; complications; and duration before subsequent oncological treatment. Independent-sample t-tests were used to compare means between pre- and post-sLITT treatments. Survival was estimated by the Kaplan-Meier method. Multivariate logistic regression was used to analyze predictive factors for local recurrence and neurological complications.RESULTSThere were 110 patients who underwent 120 sLITT procedures. Spinal levels treated included 5 cervical, 8 lumbar, and 107 thoracic. The pre-sLITT Frankel grades were E (91.7%), D (6.7%), and C (1.7%). The preoperative ESCC grade was 1c or higher in 92% of cases. Metastases were most common from renal cell carcinoma (39%), followed by non–small cell lung carcinoma (10.8%) and other tumors (35%). The most common location of ESCC was in the vertebral body (88.3%), followed by paraspinal/foraminal (7.5%) and posterior elements (4.2%). Adjuvant radiotherapy (spinal stereotactic radiosurgery or conventional external beam radiation therapy) was performed in 87 cases (72.5%), whereas 33 procedures (27.5%) were performed as salvage after radiotherapy options were exhausted. sLITT was performed without need for spinal stabilization in 87 cases (72.5%). Post-sLITT Frankel grades were E (85%), D (10%), C (4.2%), and B (0.8%); treatment was associated with a median decrease of 2 ESCC grades. The local control rate at 1 year was 81.7%. Local control failure occurred in 25 cases (20.8%). The median progression-free survival was not reached, and overall survival was 14 months. Tumor location in the paraspinal region and salvage treatment were independent predictors of local recurrence, with hazard ratios of 6.3 and 3.3, respectively (p = 0.01). Complications were observed in 22 cases (18.3%). sLITT procedures performed in the lumbar and cervical spine had hazard ratios for neurological complications of 15.4 and 17.1 (p < 0.01), respectively, relative to the thoracic spine.CONCLUSIONSsLITT is safe and provides effective local control for high-grade ESCC from vertebral metastases in the thoracic spine, particularly when combined with adjuvant radiotherapy. The authors propose considering sLITT as an alternative to open surgery in selected patients with spinal metastases.

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SURG-13. LASER INTERSTITIAL THERMAL THERAPY FOR RECURRENT GLIOBLASTOMA: A REVIEW OF SURVIVAL OUTCOMES COMPARED TO A MATCHED SURGICAL COHORT

Neuro-Oncology ◽

10.1093/neuonc/noaa215.860 ◽

2020 ◽

Vol 22 (Supplement_2) ◽

pp. ii206-ii206

Author(s):

Hassan Fadel ◽

Sameah Haider ◽

Jacob Pawloski ◽

Hesham Zakaria ◽

Farhan Chaudhry ◽

...

Keyword(s):

Surgical Resection ◽

Subgroup Analysis ◽

Tumor Volume ◽

Progression Free Survival ◽

Recurrent Glioblastoma ◽

Thermal Therapy ◽

Survival Outcomes ◽

Repeat Surgery ◽

Laser Interstitial Thermal Therapy ◽

Recurrent Gbm

Abstract INTRODUCTION Glioblastoma (GBM) is uniformly associated with a poor prognosis and inevitable recurrence. Management of recurrent GBM remains unclear, with repeat surgery often employed with varying degrees of success. We evaluated the efficacy of Laser Interstitial Thermal Therapy (LITT) for recurrent GBM when compared to a carefully matched cohort of patients treated with repeat surgical resection. METHODS A retrospective single-institution database was used to identify patients who underwent LITT or surgical resection of recurrent GBM between 2014-2019. LITT patients were matched with surgical resection patients according to baseline demographics, comorbidities, tumor location, and eloquence. Subgroup analysis matching similar patients for tumor volume was also completed. Overall survival (OS) and progression-free survival (PFS) were the primary endpoints. RESULTS A LITT cohort of 20 patients was matched to 50 similar patients who underwent repeat surgical resection. Baseline characteristics were similar between both cohorts apart from tumor volume, which was larger in the surgical cohort (17.5 cc vs. 4.7 cc, p< 0.01). On long-term follow-up, there was no difference in OS (HR, 0.72; 95%CI, 0.36-1.45) or PFS (HR, 0.67; 95%CI, 0.29-1.53) between the LITT and surgical cohorts when controlling for tumor volume. Subgroup analysis of 23 LITT patients matched according to tumor volume with 23 surgical patients with similar clinical characteristics also found no difference in OS (HR, 0.66; 95%CI, 0.33-1.30) or PFS (HR, 0.58; 95%CI, 0.90-1.05) between the cohorts. LITT patients had shorter length of stays (1 vs. 4 days, p< 0.001) and a higher rate of home discharge (84% vs. 67%, p=0.172) compared to the surgical cohort. CONCLUSION After matching for demographic, clinical, and tumor characteristics, there was no difference in outcomes between patients undergoing LITT compared to surgical resection for recurrent GBM. LITT patients had similar survival outcomes yet shorter hospital stays and more favorable dispositions, potentially mitigating post-treatment complications.

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NCOG-65. MR-GUIDED LASER INTERSTITIAL THERMAL THERAPY FOR BRAIN TUMORS IN GERIATRIC PATIENTS

Neuro-Oncology ◽

10.1093/neuonc/noaa215.603 ◽

2020 ◽

Vol 22 (Supplement_2) ◽

pp. ii144-ii144

Author(s):

Elizabeth Ginalis ◽

Shabbar Danish

Keyword(s):

Mortality Rate ◽

Neurological Symptom ◽

Geriatric Patients ◽

Age Groups ◽

Postoperative Mortality ◽

Thermal Therapy ◽

Partial Recovery ◽

Intracranial Tumors ◽

Laser Interstitial Thermal Therapy ◽

Significant Difference

Abstract INTRODUCTION There is a paucity of studies assessing the use of magnetic resonance-guided laser interstitial thermal therapy (LITT) in the elderly population. METHODS Geriatric patients (≥65 years) treated with LITT for intracranial tumors at a single institution from January 2011 to November 2019 were retrospectively identified. We grouped patients into two cohorts: 65-74 years (group 1) and 75 years or older (group 2). Baseline characteristics, operative parameters, postoperative course, and morbidity were recorded. RESULTS There were 55 patients who underwent 64 distinct LITT procedures. The majority of tumors (62.5%) treated were recurrent brain metastasis/radiation necrosis. The median hospital length of stay was 1 day, with no significant difference between age groups. Hospital stay was significantly longer in patients who presented with a neurological symptom and in those who experienced a postoperative complication. The majority of patients (68.3%) were discharged to their preoperative accommodation. Rate of discharge to home was not significantly different between age groups. Those discharged to rehabilitation facilities were more likely to have presented with a neurological symptom. Nine patients (14.1%) were found to have acute neurological complications, with nearly all patients showing complete or partial recovery at follow-up. The 30-day postoperative mortality rate was 1.6% (n = 1). The complication and 30-day postoperative mortality rate were not significantly different between age groups. CONCLUSIONS LITT can be considered as a minimally invasive and safe neurosurgical procedure for treatment of intracranial tumors in geriatric patients. Careful preoperative preparation and postoperative care is essential as LITT is not without risk. Appropriate patient selection for cranial surgery is essential as neurosurgeons treat an increasing number of elderly patients, but advanced age alone should not exclude patients from LITT.

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