Stereotactic laser ablation as treatment for brain metastases that recur after stereotactic radiosurgery: a multiinstitutional experience

Abstract

<jats:sec> <jats:title>OBJECTIVE</jats:title> <jats:p>Therapeutic options for brain metastases (BMs) that recur after stereotactic radiosurgery (SRS) remain limited.</jats:p></jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>The authors provide the collective experience of 4 institutions where treatment of BMs that recurred after SRS was performed with stereotactic laser ablation (SLA).</jats:p></jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>Twenty-six BMs (in 23 patients) that recurred after SRS were treated with SLA (2 patients each underwent 2 SLAs for separate lesions, and a third underwent 2 serial SLAs for discrete BMs). Histological findings in the BMs treated included the following: breast (n = 6); lung (n = 6); melanoma (n = 5); colon (n = 2); ovarian (n = 1); bladder (n = 1); esophageal (n = 1); and sarcoma (n = 1). With a median follow-up duration of 141 days (range 64–794 days), 9 of the SLA-treated BMs progressed despite treatment (35%). All cases of progression occurred in BMs in which &lt; 80% ablation was achieved, whereas no disease progression was observed in BMs in which ≥ 80% ablation was achieved. Five BMs were treated with SLA, followed 1 month later by adjuvant SRS (5 Gy daily × 5 days). No disease progression was observed in these patients despite ablation efficiency of &lt; 80%, suggesting that adjuvant hypofractionated SRS enhances the efficacy of SLA. Of the 23 SLA-treated patients, 3 suffered transient hemiparesis (13%), 1 developed hydrocephalus requiring temporary ventricular drainage (4%), and 1 patient who underwent SLA of a 28.9-cm<jats:sup>3</jats:sup> lesion suffered a neurological deficit requiring an emergency hemicraniectomy (4%). Although there is significant heterogeneity in corticosteroid treatment post-SLA, most patients underwent a 2-week taper.</jats:p></jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>Stereotactic laser ablation is an effective treatment option for BMs in which SRS fails. Ablation of ≥ 80% of BMs is associated with decreased risk of disease progression. The efficacy of SLA in this setting may be augmented by adjuvant hypofractionated SRS.</jats:p></jats:sec>

Operative and peri‐operative considerations in the management of brain metastasis

“…The study, however, was not designed to demonstrate treatment efficacy, and follow‐up is greatly limited. Ali et al showed LITT to abort radiographic progression in 23 patients with recurrent BM after SRS when coverage of the lesion exceeded 80% . These results underscore the importance of complete ablation to achieve local control.…”

MR-Guided Laser Interstitial Thermal Therapy for Treatment of Brain Tumors

“…A subsequent Phase I clinical trial by the same authors, published in 2011, reported 6-month local control rates of 60 and 85% for partially and fully-ablated metastatic tumors, respectively [36]. In 2016, Ali et al identified an 80% extent of ablation threshold, below which all cases eventually recurred [37]. Similarly, Ahluwalia et al reported a 0% recurrence rate in 100% ablated lesions [38].…”

Laser Ablation of a Nonlesional Cingulate Gyrus Epileptogenic Zone Using Robotic-Assisted Stereotactic EEG Localization: A Case Report

“…Minimally invasive laser ablation was then chosen for EZ destruction, as its safe use has been described for a multitude of neurosurgical applications, including deep primary/metastatic brain tumors, hypothalamic and intraventricular lesions, and epileptic foci in adult and pediatric patients [16-22]. Data relating to the ablation of eloquent EZ in pediatric patients are nonetheless currently limited to small series [15, 23].…”