Long-Term Follow-up of 25 Cases of Biopsy-Proven Radiation Necrosis or Post-Radiation Treatment Effect Treated With Magnetic Resonance-Guided Laser Interstitial Thermal Therapy.

Department

Neurosurgery

Document Type

Article

Abstract

BACKGROUND: Magnetic resonance-guided laser-induced thermal therapy (MRgLITT) is a minimally invasive surgical treatment for progressive neoplasms and post-radiation treatment effect (PRTE).

OBJECTIVE: To evaluate the radiographic response and efficacy of MRgLITT for biopsy-confirmed PRTE and the quality-of-life outcomes of patients following MRgLITT.

METHODS: We conducted a single-center retrospective study of radiographic responses and clinical outcomes of 25 patients with previously treated primary or secondary brain neoplasms (World Health Organization grades 4 [n = 8], 3 [n = 5], 2 [n = 5]) and metastatic brain tumors (n = 7). MRgLITT was applied directly following stereotactic needle biopsy confirming PRTE without any evidence of tumor presence.

RESULTS: Mean overall survival times (months) for grades 4 and 3 and for metastatic brain tumors were 39.2 (standard error [SE], 7.6; 95% confidence interval [CI], 24.3-54.1), 29.1 (SE, 7.7; 95% CI, 14.0-44.2), and 55.9 (SE, 10.0; 95% CI, 36.3-75.4), respectively. Mean progression-free survival times after MRgLITT were 9.1 (SE, 3.6; 95% CI, 2.1-16.1), 8.5 (SE, 2.4; 95% CI, 3.9-13.2), and 11.4 (SE, 3.9; 95% CI, 3.8-19.0), respectively. Mean survival times after MRgLITT were 13.1 (SE, 2.3; 95% CI, 8.5-17.6), 12.2 (SE, 4.0; 95% CI, 4.4-20.0), and 19.2 (SE, 5.3; 95% CI, 8.9-29.6), respectively. The SF-36 indicated significant overall effects on mental health (P = .029) and vitality (P = .005).

CONCLUSION: MRgLITT may be a viable option for patients with symptomatic advancing PRTE and is less invasive than open craniotomy. Although our results suggest a positive effect for MRgLITT on PRTE, prospective randomized trials with larger numbers of patients are needed to validate the study results.

ABBREVIATIONS: cRBV, relative cerebral blood volumeHIF1a, hypoxia-inducible factor 1aIMRT, intensity-modulated radiation therapyKPS, Karnofsky Performance StatusLITT, laser-induced thermal therapyMBT, metastatic brain tumorMRgLITT, magnetic resonance-guided laser-induced thermal therapyPRTE, post-radiation treatment effectSRS, stereotactic radiosurgeryVEGF, vascular endothelial growth factorWBXRT, whole brain radiation therapy.

Medical Subject Headings

Adult; Aged; Aged, 80 and over; Biopsy; Brain Neoplasms; Female; Follow-Up Studies; Humans; Hyperthermia, Induced; Laser Therapy; Magnetic Resonance Imaging, Interventional; Male; Middle Aged; Necrosis; Quality of Life; Radiation Injuries; Retrospective Studies; Stereotaxic Techniques; Survival Analysis; Time Factors; Young Adult

Publication Date

12-1-2016

Publication Title

Neurosurgery

ISSN

1524-4040

Volume

79 Suppl 1

First Page

59

Last Page

59

PubMed ID

27861326

Digital Object Identifier (DOI)

10.1227/NEU.0000000000001438

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