A Systematic Review and Meta-Analysis of Studies Examining the Use of Brain Laser Interstitial Thermal Therapy versus Craniotomy for the Treatment of High-Grade Tumors in or near Areas of Eloquence: An Examination of the Extent of Resection and Major Complication Rates Associated with Each Type of Surgery

Barnett, Gene H.; Voigt, Jeffrey; Alhuwalia, Manmeet S

doi:10.1159/000446247

Cited by 51 publications

(32 citation statements)

References 47 publications

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“…Special consideration should be taken to provide the highest-quality healthcare for older metastatic brain tumor patients and those from a non-home admission source. Evaluation of baseline health status and comorbid conditions should help guide surgical decision making and the consideration of possible non-operative management in frail older patients [ 47 , 48 ]. Our study also established surgery duration as an independent predictor for increased total hospital costs among metastatic brain tumor patients.…”

Section: Discussionmentioning

confidence: 99%

A novel online calculator predicting short-term postoperative outcomes in patients with metastatic brain tumors

et al. 2020

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Purpose Establishing predictors of hospital length of stay (LOS), discharge deposition, and total hospital charges is essential to providing high-quality, value-based care. Though previous research has investigated these outcomes for patients with metastatic brain tumors, there are currently no tools that synthesize such research findings and allow for prediction of these outcomes on a patient-by-patient basis. The present study sought to develop a prediction calculator that uses patient demographic and clinical information to predict extended hospital length of stay, non-routine discharge disposition, and high total hospital charges for patients with metastatic brain tumors. Methods Patients undergoing surgery for metastatic brain tumors at a single academic institution were analyzed (2017–2019). Multivariate logistic regression was used to identify independent predictors of extended LOS (> 7 days), non-routine discharge, and high total hospital charges (> $ 46,082.63). p < 0.05 was considered statistically significant. C-statistics and the Hosmer–Lemeshow test were used to assess model discrimination and calibration, respectively. Results A total of 235 patients were included in our analysis, with a mean age of 62.74 years. The majority of patients were female (52.3%) and Caucasian (76.6%). Our models predicting extended LOS, non-routine discharge, and high hospital charges had optimism-corrected c-statistics > 0.7, and all three models demonstrated adequate calibration (p > 0.05). The final models are available as an online calculator ( https://neurooncsurgery.shinyapps.io/brain_mets_calculator/ ). Conclusions Our models predicting postoperative outcomes allow for individualized risk-estimation for patients following surgery for metastatic brain tumors. Our results may be useful in helping clinicians to provide resource-conscious, high-value care.

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Section: Discussionmentioning

confidence: 99%

A novel online calculator predicting short-term postoperative outcomes in patients with metastatic brain tumors

et al. 2020

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“…These findings have relevance to recently introduced initiatives by Medicare to provide less costly, better quality care using ‘bundles of care.’ The BPCI program recently introduced by Medicare in October 2015 is being evaluated by thousands of providers across the country in various conditions and in various episodes of care [ 10 ]. This care entails acute hospital care and the associated aftercare post-discharge (commonly 90 days after hospital discharge).…”

Section: Discussionmentioning

confidence: 99%

“…It was assumed that patients discharged home and not receiving additional care (e.g., SNF, rehabilitation, home care) in both LITT and craniotomy did not have complications, but this may not have been the case. However, a recent systematic review and meta-analysis comparing LITT to craniotomy in patients with high-grade tumors in or near areas of eloquence found that there were significantly lower complications and significantly more of the tumor ‘excised’ with LITT [ 10 ]. As noted here, these factors relate strongly to overall survival.…”

Section: Limitationsmentioning

confidence: 99%

“…It has been found that LITT may reduce complications while at the same time resecting more of the tumor. Both of these factors are correlated to extending the lifespan of patients [ 10 ]. Medicare has recently introduced a Bundled Payment for Care Improvement (BPCI) program [ 11 ], which evaluates therapies over extended bundles of care (e.g., hospital care plus rehabilitation, nursing, and home care over a 90-day period) and pays for them as such.…”

Section: Introductionmentioning

confidence: 99%

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A Single-Center Cost Analysis of Treating Primary and Metastatic Brain Cancers with Either Brain Laser Interstitial Thermal Therapy (LITT) or Craniotomy

Leuthardt

Voigt²,

Kim

et al. 2016

PharmacoEconomics Open

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BackgroundBrain laser interstitial thermal therapy (LITT) under magnetic resonance imaging (MRI) guidance has recently gained US clinical approval for the ablation of soft, neurological tissue. LITT is a minimally invasive alternative to craniotomy.ObjectiveWhile safety and efficacy are the focus of most current LITT studies, it is unclear how acute care costs (inpatient care ± aftercare) of LITT compare to craniotomy in an academic medical center. Therefore, the purpose of this analysis is to examine these costs of using brain LITT under MRI guidance compared to craniotomy in complex anatomies.MethodsConsecutive patients treated at a single US center from 1 January 2010 to 21 October 2014 were retrospectively evaluated. Patients were included if they had a primary procedure for LITT or craniotomy (International Classification of Diseases, 9th revision, Clinical Modification [ICD-9-CM] procedure code 17.61 or ICD-9-CM procedure code 01.59, respectively) and were subgrouped according to their diagnosis of primary brain or metastatic brain cancer (ICD-9-CM 191.0–191.9 or ICD-9-CM 198.3, respectively). Patients were excluded if they had co-morbid conditions such as brain edema (ICD-9-CM 348.5). Patients were matched (LITT vs. craniotomy) based on diagnosis. Appropriate statistical analyses were undertaken to examine the year 2015 costs for care in all settings (acute hospital and post-hospital care, i.e., skilled nursing facility, rehabilitation, and home care) were examined.ResultsIn patients treated for a primary brain cancer, there was no statistical difference in the acute and post-care costs of LITT and craniotomy (inverse variance, mean difference [MD], random effects model): MD = −US$1669; 95% confidence interval (CI) −$8192 to $4854; P = 0.62. When examining difficult to access primary malignancies, no difference was found: MD = −US$4719; 95% CI −$12,183 to $2745; P = 0.22. In metastatic brain cancer, LITT was found to be significantly less costly than craniotomy: MD = −US$6522; 95% CI −$11,911 to −$1133; P = 0.02.ConclusionsIn patients with metastatic brain cancer, LITT is less costly than craniotomy. Patients receiving LITT had a significantly shorter length of hospital stay, were significantly older, and were more likely to be discharged home. The use of LITT may be a reasonable option in bundled episodes of care for brain cancer and may fit into the Bundled Payment for Care Improvement (BPCI) program being evaluated by Medicare and providers.

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“…58 Now that LITT has been developed, it is safer than resection in certain areas of the brain, with a 10% absolute risk reduction, as it is associated with less long-term neurologic morbidity and an increased rate of gross total resection compared to surgical resection. 79 …”

Section: Thermal Therapies In Brain Tumorsmentioning

confidence: 99%

Thermal Therapy Approaches for Treatment of Brain Tumors in Animals and Humans

Bredlau

McCrackin

Motamarry

et al. 2016

Crit Rev Biomed Eng

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Primary brain tumors are often aggressive, with short survival from time of diagnosis even with standard of care therapies such as surgery, chemotherapy, and radiation therapy. Thermal therapies have been extensively investigated as both primary and adjuvant therapy. Although thermal therapies are not yet widely used clinically, there have been several promising approaches demonstrated in both animals and humans. This review presents thermal therapy approaches in animal and human studies, including both hyperthermia (temperatures ~42°C–45°C) and thermal ablation (temperatures > 50°C). Hyperthermia is primarily used as adjuvant to chemotherapy and radiotherapy, and is the most widely studied radiation sensitizer where enhanced efficacy has been shown in human patients with brain cancer. Hyperthermia has additional beneficial effects such as immunogenic effects, and opening of the blood-brain barrier to potentially enhance drug delivery, for example in combination with nanoparticle drug delivery systems. Thermal ablation uses high temperatures for direct local tumor destruction, and it found its way into clinical use as laser interstitial thermal therapy (LITT). This review presents various hyperthermia and ablation approaches, including a review of different devices and methods that have been used for thermal therapies, such as radiofrequency/microwaves, laser, high-intensity focused ultrasound, and magnetic nanoparticles. Current research efforts include the combination of advanced thermal therapy devices, such as focused ultrasound with radiation, as well as the use of thermal therapies to enhance chemotherapy delivery across the blood-brain barrier.

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Cited by 51 publications

References 47 publications

A novel online calculator predicting short-term postoperative outcomes in patients with metastatic brain tumors

A novel online calculator predicting short-term postoperative outcomes in patients with metastatic brain tumors

A Single-Center Cost Analysis of Treating Primary and Metastatic Brain Cancers with Either Brain Laser Interstitial Thermal Therapy (LITT) or Craniotomy

Thermal Therapy Approaches for Treatment of Brain Tumors in Animals and Humans

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