Abstract
We analyzed volumetric response of metastatic brain tumors that progressed despite treatment with stereotactic radiosurgery (SRS) after treatment with laser interstitial thermal therapy (LITT). We retrospectively reviewed consecutive patients treated from 1/2012 to 10/2015 with LITT for metastatic brain tumors demonstrating progression after SRS. Volumes were quantified using MRI with contrast-enhanced T1-weighted (T1W) and fluid-attenuated inversion recovery (FLAIR). Fifty lesions from 36 patients were studied. Lesions were assessed prior to LITT, immediately after LITT, 0–90 days after LITT, 90–180 days after LITT, 180–270 days after LITT, and 270–360 days after LITT. The median T1W volume was 5.05 cc (range 0.54–23.31 cc) before LITT treatment (n = 50), 7.70 cc (range 1.72–38.76 cc) 0–90 days after LITT (n = 47), and 3.68 cc (range 1.282–48.31 cc) 180–270 days after LITT (n = 21). The median FLAIR volume was 43.36 cc (range 3.09–233.01 cc) before LITT treatment (n = 50), 37.13 cc (range 3.48–244.23 cc) 0–90 days after LITT (n = 43), 31.68 cc (range 1.6–248.75 cc) 180–270 days after LITT (n = 18). The 6-month FLAIR volume showed a statistically significant reduction compared to pretreatment (p = 0.04). After selecting for cases where patients had two or more post-operative MRIs, we found that 24 lesions (63%) demonstrated an overall downward trend and 14 lesions (37%) demonstrated an upward trend. The median pre-treatment T1W volume for the patients whose lesions demonstrated volumetric reduction after LITT was 3.54 cc (range 0.539–10.06 cc) and for those who did not demonstrate volumetric reduction after LITT it was 8.81 cc (range 0.926–23.313 cc). The pre-treatment tumor volume plays a significant role in determining response to LITT with smaller tumor volumes responding better to LITT than tumors with larger volumes.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Change history
11 January 2019
The original article was published with an incorrect protocol number. The correct protocol number is DR07-0585.
11 January 2019
The original article was published with an incorrect protocol number. The correct protocol number is DR07-0585.
References
Carpentier A, Chauvet D, Reina V, Beccaria K, Leclerq D, McNichols RJ, Gowda A, Cornu P, Delattre JY (2012) MR-guided laser-induced thermal therapy (LITT) for recurrent glioblastomas. Lasers Surg Med 44:361–368. https://doi.org/10.1002/lsm.22025
Carpentier A, McNichols RJ, Stafford RJ, Guichard JP, Reizine D, Delaloge S, Vicaut E, Payen D, Gowda A, George B (2011) Laser thermal therapy: real-time MRI-guided and computer-controlled procedures for metastatic brain tumors. Lasers Surg Med 43:943–950. https://doi.org/10.1002/lsm.21138
Carpentier A, McNichols RJ, Stafford RJ, Itzcovitz J, Guichard JP, Reizine D, Delaloge S, Vicaut E, Payen D, Gowda A, George B (2008) Real-time magnetic resonance-guided laser thermal therapy for focal metastatic brain tumors. Neurosurgery 63:ONS21–ONS28; discussion ONS28–ONS29. https://doi.org/10.1227/01.neu.0000335007.07381.df
Mohammadi AM, Hawasli AH, Rodriguez A, Schroeder JL, Laxton AW, Elson P, Tatter SB, Barnett GH, Leuthardt EC (2014) The role of laser interstitial thermal therapy in enhancing progression-free survival of difficult-to-access high-grade gliomas: a multicenter study. Cancer Med 3:971–979. https://doi.org/10.1002/cam4.266
Rahmathulla G, Recinos PF, Kamian K, Mohammadi AM, Ahluwalia MS, Barnett GH (2014) MRI-guided laser interstitial thermal therapy in neuro-oncology: a review of its current clinical applications. Oncology 87:67–82. https://doi.org/10.1159/000362817
Schulze PC, Vitzthum HE, Goldammer A, Schneider JP, Schober R (2004) Laser-induced thermotherapy of neoplastic lesions in the brain—underlying tissue alterations, MRI-monitoring and clinical applicability. Acta Neurochir 146:803–812. https://doi.org/10.1007/s00701-004-0293-5
Rahmathulla G, Recinos PF, Valerio JE, Chao S, Barnett GH (2012) Laser interstitial thermal therapy for focal cerebral radiation necrosis: a case report and literature review. Stereotact Funct Neurosurg 90:192–200. https://doi.org/10.1159/000338251
Rao MS, Hargreaves EL, Khan AJ, Haffty BG, Danish SF (2014) Magnetic resonance-guided laser ablation improves local control for postradiosurgery recurrence and/or radiation necrosis. Neurosurgery 74:658–667; discussion 667. https://doi.org/10.1227/NEU.0000000000000332
Sharma M, Balasubramanian S, Silva D, Barnett GH, Mohammadi AM (2016) Laser interstitial thermal therapy in the management of brain metastasis and radiation necrosis after radiosurgery: an overview. Expert Rev Neurother 16:223–232. https://doi.org/10.1586/14737175.2016.1135736
Torres-Reveron J, Tomasiewicz HC, Shetty A, Amankulor NM, Chiang VL (2013) Stereotactic laser induced thermotherapy (LITT): a novel treatment for brain lesions regrowing after radiosurgery. J Neuro Oncol 113:495–503. https://doi.org/10.1007/s11060-013-1142-2
Sneed PK, Mendez J, Vemer-van den Hoek JG, Seymour ZA, Ma L, Molinaro AM, Fogh SE, Nakamura JL, McDermott MW (2015) Adverse radiation effect after stereotactic radiosurgery for brain metastases: incidence, time course, and risk factors. J Neurosurg 123:373–386. https://doi.org/10.3171/2014.10.JNS141610
Levin VA, Bidaut L, Hou P, Kumar AJ, Wefel JS, Bekele BN, Grewal J, Prabhu S, Loghin M, Gilbert MR, Jackson EF (2011) Randomized double-blind placebo-controlled trial of bevacizumab therapy for radiation necrosis of the central nervous system. Int J Radiat Oncol Biol Phys 79:1487–1495. https://doi.org/10.1016/j.ijrobp.2009.12.061
Schwabe B, Kahn T, Harth T, Ulrich F, Schwarzmaier HJ (1997) Laser-induced thermal lesions in the human brain: short- and long-term appearance on MRI. J Comput Assist Tomogr 21:818–825
Thomas JG, Rao G, Kew Y, Prabhu SS (2016) Laser interstitial thermal therapy for newly diagnosed and recurrent glioblastoma. Neurosurg Focus 41:E12. https://doi.org/10.3171/2016.7.FOCUS16234
Funding
This work was supported by the Cancer Center Support Grant from the National Institutes of Health (P30 CA016672).
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare no conflicts of interest.
Ethical approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was approved by the Institutional Review Board (Protocol PA17-0169) which grants a waiver of consent for this retrospective study.
Rights and permissions
About this article
Cite this article
Beechar, V.B., Prabhu, S.S., Bastos, D. et al. Volumetric response of progressing post-SRS lesions treated with laser interstitial thermal therapy. J Neurooncol 137, 57–65 (2018). https://doi.org/10.1007/s11060-017-2694-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11060-017-2694-3