Laser interstitial thermal therapy in gliomas

doi:10.1016/j.canlet.2020.01.024

Cancer Letters

Volume 474, 1 April 2020, Pages 151-157

https://doi.org/10.1016/j.canlet.2020.01.024 Get rights and content

Highlights

•
Laser interstitial thermal therapy as a minimally invasive treatment for glioma.
•
Breakdown of the blood brain barrier following LITT -- adjuvant chemotherapy or radiotherapy.
•
Combination of LITT and immediate immunotherapy for butterfly gliomas.

Abstract

Laser interstitial thermal therapy (LITT) has been used for brain metastasis, epilepsy, and necrosis, as well as gliomas as a minimally invasive treatment for many years. With the improvement of the thermal monitoring and ablation precision, especially the application of magnetic resonance (MR) thermography in the procedure and the available two commercial laser systems nowadays, LITT is gradually accepted by more neurosurgical centers. Recently, some new concepts, for example the adjuvant chemotherapy or radiation following LITT, the combination of immunotherapy and LITT regarding the glioma treatment are proposed and currently being investigated. The aim of this study is to summarize the evolution of LITT especially for brain gliomas and a possible outlook of the future.

Section snippets

Origins of laser thermotherapy

The term is an acronym for Light Amplification by Stimulated Emission of Radiation, which first appeared as a term in 1959. Laser thermal therapy was clinically used for tissue ablation in 1966, based on the theory that the energy produced by laser light could achieve a high peak power through a ruby tip and could be absorbed by the surrounding tissue as heat [1]. However, using lasers for destroying neoplasms was still problematic because of the lack of a mechanism to monitor and control the

Scientific evolution of pre-commercial clinical laser therapy in the brain

Before the Visualase system was approved in 2007, more than 20 studies had been reported to use Nd:YAG lasers for cerebral gliomas [2]. During that scientific period, the laser treatment was commonly called LITT, but also named interstitial thermo-therapy (ITT) or hyperthermia (HT) in some publications [4,14]. Sugiyama et al. firstly reported a clinical series of 3 glioma cases mixed with 2 metastatic lesions treated by laser in 1990, in which thermocouples were used for temperature control [3

Commercial era of LITT

Currently, two commercial laser systems are clinically available. One is the Visualase Thermal Therapy System with diode lasers that transmit energy at a wavelength of 980 nm, which was approved by the United States Food and Drug Administration (FDA) in 2007. It was also approved in Europe by the CE (Conformité Européenne) in 2018. The other system is the NeuroBlate method with the Nd:YAG laser at a wavelength of 1064, which gained approval from FDA in 2009. Several studies have detailed these

LITT in gliomas

Theoretically, glioma may not be an optimal indication for LITT treatment because of often irregular shape of the target and the invasive character of the pathology, even if the precise ablation and real-time monitoring are achievable. Fig. 2 shows one case with irregular shape that could not be completely ablated. However, it is reasonable as a minimally invasive choice in the following circumstances: patients too sick for a craniotomy, some gliomas that are deeply seated or involving eloquent

Outlook for LITT

Prospective randomized or case-control trials demonstrating a statistically significant effect of LITT in gliomas remain lacking. However, there is solid rationale for believing that targeted treatment in focal lesions or in combination with immunotherapy could lead to positive results [18]. Several studies are ongoing and registered. Some have been closed but remain unpublished to date. Those ongoing and promising focus on shortening the treatment time by replacing open surgery with LITT and

Future directions

There is still much we do not know about the interaction between catheter-delivered fiberoptic laser therapy and gliomas. Better understanding of the effect of the laser on glioma tissue and the surrounding brain may allow for alterations in the timing and intensity of treatment. It is possible that the effect of heat could be used to provoke an immunological response in gliomas or improve the penetration of chemotherapy, as discussed above, or even increase the sensitivity to radiation.

Conclusion

LITT is currently used as a treatment for some focal recurrent glioma lesions on a personalized basis. Only well-designed randomized trials could lift this ablation treatment to a higher standard. The concepts of superior efficacy of immunotherapy through disruption of the BBB has been proposed, but still lacks proof as well. Overall, a significant benefit of LITT for gliomas might well rely on advances in immunotherapy and other systemic therapies that benefit from BBB disruption might have on

Declaration of competing interest

The authors declare no conflict of interest.

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The study included 6 patients, with a mean age of 67 ± 7.6 years [range, 54–70 years]. No major complications were observed. Median PFS was 7.5 months [IQR 3.75–9.75] and 6-month PFS was 50%. Median post-iMRgC survival was 9 months [IQR 7.5–15.25] and 6-month post-iMRgC survival was 80%. Median OS was 22.5 months [IQR 21.75–30].
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View full text

Laser interstitial thermal therapy in gliomas

Highlights

Abstract

Section snippets

Origins of laser thermotherapy

Scientific evolution of pre-commercial clinical laser therapy in the brain

Commercial era of LITT

LITT in gliomas

Outlook for LITT

Future directions

Conclusion

Declaration of competing interest

Eur. J. Radiol.

Int. J. Radiat. Oncol. Biol. Phys.

Med. Laser Appl.

World Neurosurg.

World Neurosurg.

Reaction of neoplasm and brain to laser

Arch. Neurol.

Phototherapy in tumors

World J. Surg.

Stereotactic interstitial laser-hyperthermia using Nd-YAG laser

Stereotact. Funct. Neurosurg.

Stereotactic laser therapy in cerebral gliomas

Acta Neurochir. Suppl.

Laser interstitial thermotherapy in stereotactical neurosurgery

Laser Med. Sci.

MRI-guided laser-induced interstitial thermotherapy of cerebral neoplasms

J. Comput. Assist. Tomogr.

Modeling of MR-guided laser-induced interstitial thermotherapy

Photon. West

MR-monitored LITT as a palliative concept in patients with high grade gliomas: preliminary clinical experience

J. Magn. Reson. Imag. : JMRI

Stereotactic-guided laser-induced interstitial thermotherapy (SLITT) in gliomas with intraoperative morphologic monitoring in open MR

Minim. Invasive Neurosurg. : MIN

Laser-induced thermotherapy of neoplastic lesions in the brain--underlying tissue alterations, MRI-monitoring and clinical applicability

Acta Neurochir.

MRI-guided laser interstitial thermal therapy for the treatment of low-grade gliomas in children: a case-series review, description of the current technologies and perspectives

Child's Nerv. Syst. : ChNS : Off. J. Int. Soc. Pediatr. Neurosurg.

The role of laser-induced thermal therapy in the management of malignant gliomas

Stereotactic guided laser-induced interstitial thermotherapy (SLITT) in gliomas with intraoperative morphologic monitoring in an open MR: clinical expierence

Minim. Invasive Neurosurg.: MIN

11C-Methionine positron emission tomographic imaging of biologic activity of a recurrent glioblastoma treated with stereotaxy-guided laser-induced interstitial thermotherapy

Mol. Imag.

Laser-induced interstitial thermotherapy of gliomas

Prog. Neurol. Surg.

MR-guided laser-induced thermal therapy (LITT) for recurrent glioblastomas

Laser Surg. Med.

Results of the NeuroBlate System first-in-humans Phase I clinical trial for recurrent glioblastoma: clinical article

J. Neurosurg.

Thermal injury to corticospinal tracts and postoperative motor deficits after laser interstitial thermal therapy

Neurosurg. Focus

Preliminary experience with the application of gadolinium-DTPA before MR imaging-guided laser-induced interstitial thermotherapy of brain tumors

J. Magn. Reson. Imag. : JMRI

Laser-induced thermal lesions in the human brain: short- and long-term appearance on MRI

J. Comput. Assist. Tomogr.

Computer-assisted intra-operative magnetic resonance imaging monitoring of interstitial laser therapy in the brain: a case report

J. Biomed. Optic.

In vivo MRI thermometry using a phase-sensitive sequence: preliminary experience during MRI-guided laser-induced interstitial thermotherapy of brain tumors

J. Magn. Reson. Imag. : JMRI

Treatment planning for MRI-guided laser-induced interstitial thermotherapy of brain tumors--the role of blood perfusion

J. Magn. Reson. Imag. : JMRI

Stereotactic guided laser-induced interstitial thermotherapy (SLITT) in gliomas with intraoperative morphologic monitoring in an open MR-unit

Minim. Invasive Neurosurg. : MIN