Staged Laser Interstitial Thermal Therapy (LITT) Treatments to Left Insular Low-Grade Glioma

Abstract INTRODUCTION Laser Interstitial thermal therapy (LITT) is a minimal-access procedure for intracranial tumors that are either refractory to standard treatment paradigms or difficult to access via conventional open surgery. OBJECTIVE To evaluate predictors of local disease control following LITT in patients with primary and secondary brain tumors. METHODS Single-center retrospective cohort study of all consecutive LITT ablations between 2014 and 2019. Demographic and procedural characteristics analyzed with respect to local disease control at 6 months. Chi-square tests for categorical variables, T-tests/Wilcoxon Rank-Sum tests for continuous variables for parametric and non-parametric data, respectively. Poisson regression models were used to approximate relative risk (RR) with 95% confidence intervals. RESULTS A total of 76 patients underwent LITT with a median follow up of 12.3 months; pathology at time of ablation was glioblastoma multiforme (GBM, 36%), WHO grade III primary CNS (24%), low grade CNS (20%), and metastatic lesions (19%) with respective local control rates of 26%, 20%, 29%, and 26%. Pathology of GBM (RR 0.46, 0.21-1.02, p=0.055) and a 5-year increase in age at the time of ablation (RR 0.91, 0.83-0.99, p=0.028) were associated with a lower likelihood of local control at 6 months. Preoperative Karnofsky performance status (KPS) of 100 (RR 2.04, 1.13-3.69, p=0.019) was associated with a higher likelihood of local control. Extent of ablation (EOA) demonstrated a direct relationship with local control; when EOA=100% local control was 59%, with this rate dropping down to 21% when EOA=90%. Tumor location, lesion volume, gender, BMI, ethnicity, or whether there existed multiple foci of disease at the time of ablation had no strong association with local control. CONCLUSION Our series demonstrates that preoperative performance status and age were strong predictors of local disease control following LITT. Incomplete ablation and histology of high-grade glioma portended a higher risk of local recurrence.

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MRI-guided laser interstitial thermal therapy for the treatment of low-grade gliomas in children: a case-series review, description of the current technologies and perspectives

Child s Nervous System ◽

10.1007/s00381-016-3193-0 ◽

2016 ◽

Vol 32 (10) ◽

pp. 1947-1956 ◽

Cited By ~ 21

Author(s):

Zulma Tovar-Spinoza ◽

Hoon Choi

Keyword(s):

Case Series ◽

Thermal Therapy ◽

Low Grade ◽

Low Grade Gliomas ◽

Laser Interstitial Thermal Therapy ◽

Mri Guided

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Abstract #506 Panhypopituitarism Secondary to Pituicytoma: Rare Low-Grade Glioma of the Neurohypophysis

Endocrine Practice ◽

10.1016/s1530-891x(20)46850-8 ◽

2019 ◽

Vol 25 ◽

pp. 251-252

Author(s):

Kyaw Zin Win ◽

Susana Urgiles

Keyword(s):

Low Grade Glioma ◽

Low Grade

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Development of a novel assay suitable for pre-clinical testing of MAPK inhibitors in low-grade glioma

10.1055/s-0037-1607404 ◽

2017 ◽

Author(s):

D Usta ◽

F Selt ◽

J Hohloch ◽

S Pusch ◽

SM Pfister ◽

...

Keyword(s):

Low Grade Glioma ◽

Low Grade ◽

Clinical Testing ◽

Mapk Inhibitors

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Editorial. Considering the role of surgery for low-grade glioma in the molecular genetic era

Journal of Neurosurgery ◽

10.3171/2019.7.jns191747 ◽

2020 ◽

Vol 133 (5) ◽

pp. 1288-1290

Author(s):

Michael A. Vogelbaum

Keyword(s):

Molecular Genetic ◽

Low Grade Glioma ◽

Low Grade

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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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