MR thermometry‐based feedback control of laser interstitial thermal therapy at 980 nm

McNichols, Roger J.; Gowda, Ashok; Kangasniemi, Marko; Bankson, James A.; Price, Roger E.; Hazle, John D.

doi:10.1002/lsm.10243

Cited by 198 publications

(137 citation statements)

References 27 publications

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“…12 Magnetic resonance imaging guided-LITT employs thermal energy generated by a diode laser and transmitted to surrounding tissues. Precise laser applicator placement can be ensured by intraoperative MRI.…”

Section: 20mentioning

confidence: 99%

Magnetic resonance imaging–guided laser interstitial thermal therapy for previously treated hypothalamic hamartomas

Burrows¹,

Marsh²,

Worrell

et al. 2016

FOC

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OBJECTIVE Hypothalamic hamartomas (HHs) are associated with gelastic seizures and the development of medically refractory epilepsy. Magnetic resonance imaging–guided laser interstitial thermal therapy (MRg-LITT) is a minimally invasive ablative treatment that may have applicability for these deep-seated lesions. Here, the authors describe 3 patients with refractory HHs who they treated with MRg-LITT. METHODS An institutional review board–approved prospective database of patients undergoing Visualase MRg-LITT was retrospectively reviewed. Demographic and historical medical data, including seizure and medication histories, previous surgeries, procedural details, and surgical complications, along with radiological interpretation of the HHs, were recorded. The primary outcome was seizure freedom, and secondary outcomes included medication reduction, seizure frequency, operative morbidity, and clinical outcome at the latest follow-up. RESULTS All 3 patients in the multi-institutional database had developed gelastic seizures related to HH at the ages of 7, 7, and 9 years. They presented for further treatment at 25, 28, and 48 years of age, after previous treatments with stereotactic radiosurgery in all cases and partial hamartoma resection in one case. One ablation was complicated by a small tract hemorrhage, which was stable on postoperative imaging. One patient developed hyponatremia and experienced weight gain, which were respectively managed with fluid restriction and counseling. At the most recent follow-up at a mean of 21 months (range 1–32 months), one patient was seizure free while another had meaningful seizure reduction. Medication was reduced in one case. CONCLUSIONS Adults with gelastic seizures despite previous treatments can undergo MRg-LITT with reasonable safety and efficacy. This novel therapy may provide a minimally invasive alternative for primary and recurrent HH as the technique is refined.

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Section: 20mentioning

confidence: 99%

Magnetic resonance imaging–guided laser interstitial thermal therapy for previously treated hypothalamic hamartomas

Burrows¹,

Marsh²,

Worrell

et al. 2016

FOC

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“…Overall, the fractionation regimen is prescribed based on prior irradiation history, tumor radiosensitivity, tumor volume, and number of vertebral bodies involved. All patients received either a single fraction (24 Gy) or hypofractionation (24)(25)(26)(27) Gy in 3 doses), and most patients were treated within 3 days of the ablation. The treatment plan was calculated to limit the spinal cord dose to 12 Gy and to maximally cover the gross target volume, as if no ablation had been performed.…”

Section: Delivery Of Spinal Stereotactic Radiationmentioning

confidence: 99%

“…Once the patient recovers from surgery, SSRS is contoured to cover the surgical field, and all residual tumor receives adequate tumoricidal doses of radiation since the epidural disease likely to be underdosed has been surgically removed. 4,5,22,28 Laufer et al documented a 1-year cumulative incidence of local recurrence of only 4.1% when separation surgery was used in combination with hypofractionated SSRS (24)(25)(26)(27)(28)(29)(30) Gy divided into 3 fractions) and 9% when surgery was followed by highdose single-fraction SSRS (24 Gy). 21 Percutaneous procedures for tumor ablation are widely used with the intent of local tumor control, as in the treatment of visceral 2,41 and bone metastasis.…”

mentioning

confidence: 99%

Utilization of laser interstitial thermotherapy guided by real-time thermal MRI as an alternative to separation surgery in the management of spinal metastasis

Tatsui¹,

Stafford

et al. 2015

SPI

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OBJECT High-grade malignant spinal cord compression is commonly managed with a combination of surgery aimed at removing the epidural tumor, followed by spinal stereotactic radiosurgery (SSRS) aimed at local tumor control. The authors here introduce the use of spinal laser interstitial thermotherapy (SLITT) as an alternative to surgery prior to SSRS. METHODS Patients with a high degree of epidural malignant compression due to radioresistant tumors were selected for study. Visual analog scale (VAS) scores for pain and quality of life were obtained before and within 30 and 60 days after treatment. A laser probe was percutaneously placed in the epidural space. Real-time thermal MRI was used to monitor tissue damage in the region of interest. All patients received postoperative SSRS. The maximum thickness of the epidural tumor was measured, and the degree of epidural spinal cord compression (ESCC) was scored in pre- and postprocedure MRI. RESULTS In the 11 patients eligible for study, the mean VAS score for pain decreased from 6.18 in the preoperative period to 4.27 within 30 days and 2.8 within 60 days after the procedure. A similar VAS interrogating the percentage of quality of life demonstrated improvement from 60% preoperatively to 70% within both 30 and 60 days after treatment. Imaging follow-up 2 months after the procedure demonstrated a significant reduction in the mean thickness of the epidural tumor from 8.82 mm (95% CI 7.38–10.25) before treatment to 6.36 mm (95% CI 4.65–8.07) after SLITT and SSRS (p = 0.0001). The median preoperative ESCC Grade 2 was scored as 4, which was significantly higher than the score of 2 for Grade 1b (p = 0.04) on imaging follow-up 2 months after the procedure. CONCLUTIONS The authors present the first report on an innovative minimally invasive alternative to surgery in the management of spinal metastasis. In their early experience, SLITT has provided local control with low morbidity and improvement in both pain and the quality of life of patients.

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“…A variety of trial groups are experimenting with differing imaging modalities to achieve these goals for focal therapy including contrast enhanced ultrasonography for photothermal (laser) therapy 29 and MRI-guided high intensity focused ultrasound therapy [30][31][32] and laser ablation. 33 Some authors have stated that focal therapy is inappropriate because of the multifocality of PCa. Although this may be true in general, up to one-third of patients have been found to have unifocal disease on examination of RP specimens from patients with stage T1c disease.…”

mentioning

confidence: 99%

Focal therapy for localized prostate cancer —choosing the middle ground

Lindner

Trachtenberg

2013

CUAJ

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MR thermometry‐based feedback control of laser interstitial thermal therapy at 980 nm

Abstract: The computer-controlled thermal therapy system was effective at regulating heating, eliminating carbonization and vaporization, and protecting fiberoptic applicators. MRTI estimation of thermal dose accurately predicted achieved thermal necrosis.

Cited by 198 publications

References 27 publications

Magnetic resonance imaging–guided laser interstitial thermal therapy for previously treated hypothalamic hamartomas

Magnetic resonance imaging–guided laser interstitial thermal therapy for previously treated hypothalamic hamartomas

Utilization of laser interstitial thermotherapy guided by real-time thermal MRI as an alternative to separation surgery in the management of spinal metastasis

Focal therapy for localized prostate cancer —choosing the middle ground

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