scholarly journals Laser interstitial thermal therapy for an eloquent region supratentorial brain lesion

2018 ◽  
Vol 44 (videosuppl2) ◽  
pp. V4 ◽  
Author(s):  
Mayur Sharma ◽  
Daria Krivosheya ◽  
Hamid Borghei-Razavi ◽  
Gene H. Barnett ◽  
Alireza M. Mohammadi
Keyword(s):  
Radiation Necrosis ◽  
Brain Lesion ◽  
Thermal Therapy ◽  
Centrum Semiovale ◽  
Laser Interstitial Thermal Therapy ◽  
Corticospinal Tracts ◽  
Stereotactic Technique ◽  
Close Proximity ◽  
Eloquent Area ◽  
History Of

Laser interstitial thermal therapy (LITT) is a minimally invasive stereotactic technique that causes tumor ablation using thermal energy. LITT has shown to be efficacious for the treatment of deep-seated brain lesions, including those near eloquent areas. In this video, the authors present the case of a 62-year-old man with a history of metastatic melanoma who presented with worsening right-sided hemiparesis. MRI revealed a contrast-enhancing lesion in left centrum semiovale in close proximity to corticospinal tracts, consistent with radiation necrosis. The authors review their stepwise technique of LITT with special attention to details for a lesion located near eloquent area.The video can be found here: https://youtu.be/ndrTgi6MXqE.

scholarly journals SURG-06. LASER INTERSTITIAL THERMAL THERAPY COMPARED TO CRANIOTOMY FOR TREATMENT OF RADIATION NECROSIS OR RECURRENT TUMOR IN BRAIN METASTASES FAILING RADIOSURGERY

2019 ◽  
Vol 1 (Supplement_1) ◽  
pp. i31-i32
Author(s):  
Christopher Hong ◽  
Di Deng ◽  
Nanthiya Sujijantarat ◽  
Alberto Vera ◽  
Veronica Chiang
Keyword(s):  
Brain Metastases ◽  
Radiation Necrosis ◽  
Symptom Relief ◽  
Group Analysis ◽  
Progression Free Survival ◽  
Thermal Therapy ◽  
Recurrent Tumor ◽  
Laser Interstitial Thermal Therapy ◽  
Neurological Outcomes ◽  
Significant Difference

Abstract Many publications report laser-interstitial thermal therapy (LITT) as a viable alternative treatment to craniotomy for radiation necrosis (RN) and re-growing tumor occurring after stereotactic radiosurgery (SRS) for brain metastases. No studies to-date have compared the two options. The aim of this study was to retrospectively compare outcomes after LITT versus craniotomy for regrowing lesions in patients previously treated with SRS for brain metastases. Data were collected from a single-institution chart review of patients treated with LITT or craniotomy for previously irradiated brain metastasis. Of 75 patients, 42 had recurrent tumor (56%) and 33 (44%) had RN. Of patients with tumor, 26 underwent craniotomy and 16 LITT. For RN, 15 had craniotomy and 18 LITT. There was no significant difference between LITT and craniotomy in ability to taper off steroids or neurological outcomes. Progression-free survival (PFS) and overall survival (OS) were similar for LITT versus craniotomy, respectively: %PFS-survival at 1-year = 72.2% versus 61.1%, %PFS-survival at 2-years = 60.0% versus 61.1%, p = 0.72; %OS-survival at 1-year = 69.0% versus 69.3%, %OS-survival at 2-years = 56.6% versus 49.5%, p = 0.90. This finding persisted on sub-analysis of smaller lesions under < 3cm in diameter. Craniotomy resulted in higher rates of pre-operative deficit improvement than LITT (p < 0.01). On sub-group analysis, the single factor most significantly associated with OS and PFS was pathology of the lesion. About 40% of tumor lesions needed post-operative salvage with radiation after both craniotomy and LITT. LITT was as efficacious as craniotomy in achieving local control of recurrent irradiated brain metastases and facilitating steroid taper, regardless of pathology. Craniotomy appears to be more advantageous for providing symptom relief in those with pre-operative symptoms.

Laser interstitial thermal therapy (LITT) vs. bevacizumab for radiation necrosis in previously irradiated brain metastases

2020 ◽  
Vol 148 (3) ◽  
pp. 641-649 ◽  
Author(s):  
Nanthiya Sujijantarat ◽  
Christopher S. Hong ◽  
Kent A. Owusu ◽  
Aladine A. Elsamadicy ◽  
Joseph P. Antonios ◽  
...  
Keyword(s):  
Brain Metastases ◽  
Radiation Necrosis ◽  
Thermal Therapy ◽  
Laser Interstitial Thermal Therapy

scholarly journals Laser Interstitial Thermal Therapy for Focal Cerebral Radiation Necrosis: A Case Report and Literature Review

2012 ◽  
Vol 90 (3) ◽  
pp. 192-200 ◽  
Author(s):  
Gazanfar Rahmathulla ◽  
Pablo F. Recinos ◽  
Jose E. Valerio ◽  
Sam Chao ◽  
Gene H. Barnett
Keyword(s):  
Case Report ◽  
Literature Review ◽  
Radiation Necrosis ◽  
Thermal Therapy ◽  
Laser Interstitial Thermal Therapy ◽  
Cerebral Radiation Necrosis

Laser interstitial thermal therapy in the management of brain metastasis and radiation necrosis after radiosurgery: An overview

2016 ◽  
Vol 16 (2) ◽  
pp. 223-232 ◽  
Author(s):  
Mayur Sharma ◽  
Suresh Balasubramanian ◽  
Danilo Silva ◽  
Gene H. Barnett ◽  
Alireza M. Mohammadi
Keyword(s):  
Brain Metastasis ◽  
Radiation Necrosis ◽  
Thermal Therapy ◽  
Laser Interstitial Thermal Therapy

Radical Laser Interstitial Thermal Therapy Ablation Volumes Increase Progression-Free Survival in Biopsy-Proven Radiation Necrosis

2020 ◽  
Vol 136 ◽  
pp. e646-e659 ◽  
Author(s):  
Evan Luther ◽  
David McCarthy ◽  
Ashish Shah ◽  
Alexa Semonche ◽  
Veronica Borowy ◽  
...  
Keyword(s):  
Radiation Necrosis ◽  
Progression Free Survival ◽  
Thermal Therapy ◽  
Free Survival ◽  
Laser Interstitial Thermal Therapy

MRI-Guided Laser Interstitial Thermal Therapy for Radiation Necrosis in Previously Irradiated Brain Arteriovenous Malformations

2020 ◽  
Vol 10 (4) ◽  
pp. e298-e303 ◽  
Author(s):  
Christopher S. Hong ◽  
Branden J. Cord ◽  
Adam J. Kundishora ◽  
Aladine A. Elsamadicy ◽  
Jason M. Beckta ◽  
...  
Keyword(s):  
Arteriovenous Malformations ◽  
Radiation Necrosis ◽  
Thermal Therapy ◽  
Laser Interstitial Thermal Therapy ◽  
Brain Arteriovenous Malformations ◽  
Mri Guided

scholarly journals SURG-03. COMBINATION LASER INTERSTITIAL THERMAL THERAPY PLUS SRS INCREASES TIME TO PROGRESSION FOR RECURRENT SRS-TREATED BRAIN METASTASES

2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii203-ii203
Author(s):  
Matthew Grabowski ◽  
Eric Sankey ◽  
Ethan Srinivasan ◽  
Balint Otvos ◽  
Alex Scott ◽  
...  
Keyword(s):  
Brain Metastases ◽  
Tumor Volume ◽  
Radiographic Progression ◽  
Radiation Necrosis ◽  
Thermal Therapy ◽  
Time To Progression ◽  
Index Lesion ◽  
Laser Interstitial Thermal Therapy ◽  
Prospective Trials

Abstract INTRODUCTION Laser interstitial thermal therapy (LITT) has evolved as an effective treatment for brain metastases (BM) failing stereotactic radiosurgery (SRS), and an alternative to open resection/repeat SRS. We sought to evaluate the efficacy of LITT+SRS in recurrent SRS-treated BM, and compare outcomes to LITT alone vs. repeat SRS. METHODS A multicenter, retrospective study was performed of patients with biopsy-proven BM recurrence after SRS. Patients were stratified by planned LITT+SRS vs. LITT alone vs. repeat SRS. Index lesion progression was determined by RANO criteria. RESULTS Forty-five patients fit inclusion, with a median follow-up of 7.3 months (range:1.1-30.5), age of 60 (range:37-86), KPS of 80 (range:60-100), and contrasted tumor volume (CTV) of 6.1cc (range:1.4-19.4). Histologies included NSCLC (44%), breast (24%), SCLC, melanoma, colon, and oroesophageal (< 10% each). Sixty-three percent of patients underwent LITT alone, 18% had repeat SRS, while 27% had LITT+SRS (post-LITT SRS). Median time to index lesion progression was greatest in the LITT+SRS group compared to LITT alone or repeat SRS (>23, 7.5, and 3.6 months, respectively [p=0.018]), as was overall survival (23.7, 5.9, and 7.0 months, respectively [p=0.023]). Age, sex, primary histology, CTV, and treatment strategy were univariate predictors of tumor progression; patients not treated with LITT+SRS were more likely to have index lesion progression (p=0.016). When controlling for histology and CTV in a multivariate model, patients not treated with LITT+SRS were significantly more likely to have progression (p=0.001). All LITT+SRS patients who experienced subsequent radiographic progression were diagnosed with recurrent tumor, while radiation necrosis incidence in the repeat SRS arm was 25%. CONCLUSION LITT+SRS appears superior to LITT alone or repeat SRS for treatment of biopsy-proven BM recurrence after SRS when controlling for other variables known to be predictive of progression. Prospective trials should be designed to validate the utility of combination LITT+SRS after SRS failure.

scholarly journals INNV-02. RADIOGRAPHIC CHARACTERISTICS AND STEROID USAGE IN LASER INTERSTITIAL THERMAL THERAPY VERSUS MEDICAL MANAGEMENT FOR BIOPSY-PROVEN RADIATION NECROSIS AFTER STEREOTACTIC RADIOSURGERY OF BRAIN METASTASES

2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii116-ii117
Author(s):  
Ethan Srinivasan ◽  
Eric Sankey ◽  
Matthew Grabowski ◽  
Andrew Griffin ◽  
Elizabeth Howell ◽  
...  
Keyword(s):  
Brain Metastases ◽  
Treatment Failure ◽  
Stereotactic Radiosurgery ◽  
Medical Management ◽  
Radiation Necrosis ◽  
Thermal Therapy ◽  
Response To Treatment ◽  
Lesion Volume ◽  
Variable Response ◽  
Laser Interstitial Thermal Therapy

Abstract INTRODUCTION Radiation necrosis (RN) occurs in 9–14% of patients after stereotactic radiosurgery (SRS) for brain metastases (BM). Medical management (MM) with steroids is a common first-line therapy, with variable response and numerous side effects, especially regarding immunotherapy. Laser interstitial thermal therapy (LITT) has been introduced as an efficacious, steroid-reducing alternative, however limited data exists comparing LITT to MM. METHODS Patients with biopsy-proven RN after SRS for BM who received LITT or MM at two academic centers were retrospectively reviewed. Treatment failure was defined as radiographic progression that necessitated a change in management. Measurements of total (TLV) and contrast-enhancing lesion volume (ceLV) were obtained from MRI by semi-automated analysis using the BrainLab iPlan Cranial 3.0 software. RESULTS Eighty-one patients were followed for 11.7 (4.3–27.0) months and 57 (70%) received LITT. Steroid cessation occurred at a median of 37 days post-LITT compared to 162 days after MM (p< 0.01). Treatment failure occurred in 5% of LITT patients at 4.0 (3.2–4.8) months and 13% of MM patients at 4.4 (4.1–5.3) months (p >0.05). Patients were 3.2 times more likely to be weaned off steroids when treated with LITT compared to MM (p< 0.01), when controlled for age, pre-operative ceLV, and post-operative seizure on multivariate analysis. Both groups demonstrated decreasing TLV and ceLV between baseline and last follow-up MRI. At 6–9 months, the LITT cohort demonstrated a -59% change in ceLV compared to -7% with MM (p >0.05). The LITT cohort demonstrated a significant decrease in ceLV between scans at 0–2 and 6–9 months (p< 0.01). The MM group did not demonstrate a statistically significant decrease in ceLV until 12 months. CONCLUSION This study suggests that LITT for RN significantly reduces the time to steroid cessation, and earlier radiographic response to treatment by LITT. Large, prospective trials are needed to validate these findings.

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