Stereotactic Laser Ablation (SLA) followed by consolidation stereotactic radiosurgery (cSRS) as treatment for brain metastasis that recurred locally after initial radiosurgery (BMRS): a multi-institutional experience

Abstract

Introduction: The optimal treatment paradigm for brain metastasis that recurs locally after initial radiosurgery (BMRS) remains an area of active investigation. Here, we report outcomes for patients with BMRS treated with stereotactic laser ablation (SLA, also known as laser interstitial thermal therapy, LITT)followed by consolidation radiosurgery (cSRS).Methods: Clinical outcome of 20 patients with 21histologically con rmed BMRS treated with SLA followed by consolidation SRS and >6 months follow-up were collected retrospectively across three participating institutions.Results: Consolidation SRS (5 Gy x 5 or 6 Gy x 5) wascarried out 16-73 days (median of 26 days) post-SLA of BMRS. There were no new neurological de cits after SLA/cSRS. While 3/21 (14.3%) patients suffered temporary Karnofsky Performance Score (KPS) decline after SLA, no KPS declines was observed after cSRS.There were no 30-day mortalities or wound complications. Two patients required re-admission within 30 days of cSRS (severe headache that resolved with steroid therapy (n=1) and new onset seizure (n=1)). With a median follow-up of 228 days (range: 178-1367 days), the local control rate at 6 and 12 months (LC 6 , LC 12 ) was 100%. All showed diminished FLAIR volume surrounding the SLA/cSRS treated BMRS at the six-month follow-up; none of the patients required steroid for symptoms attributable to these BMRS. These results compare favorably to the available literature for repeat SRS or SLA-only treatment of BMRS.Conclusions: This multi-institutional experience supports further investigations of SLA/cSRS as a treatment strategyfor BMRS.

Stereotactic needle biopsy and laser ablation of geographically distinct lesions through a novel magnetic resonance imaging–compatible cranial stereotaxic frame: illustrative case

“… 12–14 There is increasingly compelling evidence supporting the efficacy of SLA as a treatment for primary brain cancer 2 , 14–16 and metastatic brain cancers. 5 , 17 , 18 An emerging theme in this literature is that the extent of ablation constitutes a major determinant of efficacy. In this context, the treatment of multifocal neoplastic diseases, exemplified by the case presented here, presents a technical challenge.…”

Combination laser interstitial thermal therapy plus stereotactic radiotherapy increases time to progression for biopsy-proven recurrent brain metastases

“…The case series of 20 patients treated with LITT and SRT reported by Peña Pino et al demonstrated 100% local control rates at 6 and 12 months. 41 While SRT is a widespread first-line treatment for the management of single and multiple brain metastases, recurrent tumor and RN occur in 5%–15% of SRT-treated brain lesions. 42 , 43 As OS continues to improve with the advent of more effective systemic therapies, the management of recurrent disease presents a growing neuro-oncologic challenge.…”

Advances in Brain Tumor Therapy Based on the Magnetic Nanoparticles

“…Notably, the overall survival was prolonged to 23.2 months after receiving the therapy 189 ( Figure 4A–G ). In 2022, Chen et al combined stereotactic laser ablation (SLA) and consolidation stereotactic radiosurgery (cSRS) to treat brain tumors metastasized from lung cancer, breast cancer, gastrointestinal cancer, melanoma cancer, ovarian cancer, urothelial cancer, and laryngeal cancer 190 in a study involving 20 patients. They injected 5–6 Gy MNPs and heated them to 43–60°C.…”