Laser interstitial thermal therapy for newly diagnosed and recurrent glioblastoma

Abstract

<jats:sec> <jats:title>OBJECTIVE</jats:title> <jats:p>Glioblastoma (GBM) is the most common and deadly malignant primary brain tumor. Better surgical therapies are needed for newly diagnosed GBMs that are difficult to resect and for GBMs that recur despite standard therapies. The authors reviewed their institutional experience of using laser interstitial thermal therapy (LITT) for the treatment of newly diagnosed or recurrent GBMs.</jats:p></jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>This study reports on the pre-LITT characteristics and post-LITT outcomes of 8 patients with newly diagnosed GBMs and 13 patients with recurrent GBM who underwent LITT.</jats:p></jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>Compared with the group with recurrent GBMs, the patients with newly diagnosed GBMs who underwent LITT tended to be older (60.8 vs 48.9 years), harbored larger tumors (22.4 vs 14.6 cm<jats:sup>3</jats:sup>), and a greater proportion had <jats:italic>IDH</jats:italic> wild-type GBMs. In the newly diagnosed GBM group, the median progression-free survival and the median survival after the procedure were 2 months and 8 months, respectively, and no patient demonstrated radiographic shrinkage of the tumor on follow-up imaging. In the 13 patients with recurrent GBM, 5 demonstrated a response to LITT, with radiographic shrinkage of the tumor following ablation. The median progression-free survival was 5 months, and the median survival was greater than 7 months.</jats:p></jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>In carefully selected patients with recurrent GBM, LITT may be an effective alternative to surgery as a salvage treatment. Its role in the treatment of newly diagnosed unresectable GBMs is not established yet and requires further study.</jats:p></jats:sec>

Laser interstitial thermal therapy for pediatric atypical teratoid/rhabdoid tumor: case report

“…4,6 First introduced for the treatment of brain lesions in the 1990s, LITT has demonstrated utility in a wide array of pathologies with minimal side effects, providing a viable alternative to surgical extirpation, chemotherapy, and radiation. In the adult population, LITT has been used to treat gliomas, 22 recurrent metastases, 17 radiation necrosis, 20 mesial temporal sclerosis, 16,26 epidural spinal metastasis with cord compression, 21 and other pathologies. Its advantages have also been translated to the management of pediatric pathologies, such as in the successful reduction of seizure burden in the treatment of pediatric epilepsy for etiologies including focal cortical dysplasia, 3 mesial temporal lobe sclerosis, 14 and hypothalamic hamartoma, 27 among others (Table 1).…”

Glioblastoma: Pathogenesis and Current Status of Chemotherapy and Other Novel Treatments

“…Most patients can be discharged within 24 h of post operation [148]. A study of a small group of patients has observed the efficacy of LITT in recurrent glioblastoma as an alternative to surgery [149]. Retrospective analysis also found that LITT enhances the PFS of difficult-to-access high-grade gliomas [150].…”

Combined Surgical Resection and Laser Interstitial Thermal Therapy for Glioblastoma: Technical Note

“…We then proceeded with LITT ablation of the target region (details were previously described). 17 Coverage of the tumor was optimized by superimposing the blue and yellow thermal damage threshold (TDT) lines delineated within the NeuroBlate software suite over the region of interest. When sufficient ablation coverage of the deep-seated region of the tumor was thought to be achieved, we proceeded with craniotomy to resect the remaining accessible portions of the lesion.…”

“…[10][11][12][13] Additionally, some reports in the literature describe applying LITT to deep unresectable gliomas with variable results. [14][15][16][17][18][19][20][21] Nonetheless, evidence is lacking for LITT in patients with GBM in loci not amenable to GTR. To our knowledge, this is the first reported use of concurrent surgical resection and LITT as an alternative to subtotal resection for partially deep-seated GBMs.…”