Intraoperative real-time MRI-guided stereotactic biopsy followed by laser thermal ablation for progressive brain metastases after radiosurgery

Torcuator, Roy; Hulou, M. Maher; Chavakula, Vamsidhar; Jólesz, Ferenc A.; Golby, Alexandra J.

doi:10.1016/j.jocn.2015.09.008

Cited by 15 publications

(5 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…3 While only 3 of the 4 patients had complete lesional treatment, all had improvement in their KPS score 3 months after surgery. Since then, several other investigators have detailed their experience (single cases or case series) and have described variable success with LITT for the treatment of both biopsy-proven regrowing tumor 8,19,20 and biopsy-proven RN. 4,11,16 Therefore, the current study was performed to prospectively determine the safety, efficacy, and outcome of LITT for regrowing SRS-treated lesions.…”

Section: Discussionmentioning

confidence: 99%

“…17 Anecdotally, the option of MRI-guided laser interstitial thermal therapy (LITT) has been effective for the treatment of both pathological entities after SRS when craniotomy is not feasible because of either lesion location or concerns regarding medical comorbidities. 1,3,6,11,12,14,19,20 Results from a phase I clinical trial using the NeuroBlate system (Monteris Medical Inc.) showed that the device provides neurosurgeons with a minimally invasive surgical option for tumor ablation. 15 An earlier study in 16 glioblastoma patients suggested that LITT offers a survival advantage over medical management or chemotherapy alone.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Laser ablation after stereotactic radiosurgery: a multicenter prospective study in patients with metastatic brain tumors and radiation necrosis

Ahluwalia

Barnett

Deng

et al. 2019

Journal of Neurosurgery

133

109

View full text Add to dashboard Cite

OBJECTIVE Laser Ablation After Stereotactic Radiosurgery (LAASR) is a multicenter prospective study of laser interstitial thermal (LITT) ablation in patients with radiographic progression after stereotactic radiosurgery for brain metastases. METHODS Patients with a Karnofsky Performance Scale (KPS) score ≥ 60, an age > 18 years, and surgical eligibility were included in this study. The primary outcome was local progression-free survival (PFS) assessed using the Response Assessment in Neuro-Oncology Brain Metastases (RANO-BM) criteria. Secondary outcomes were overall survival (OS), procedure safety, neurocognitive function, and quality of life. RESULTS Forty-two patients-19 with biopsy-proven radiation necrosis, 20 with recurrent tumor, and 3 with no diagnosis-were enrolled. The median age was 60 years, 64% of the subjects were female, and the median baseline KPS score was 85. Mean lesion volume was 6.4 cm (range 0.4-38.6 cm). There was no significant difference in length of stay between the recurrent tumor and radiation necrosis patients (median 2.3 vs 1.7 days, respectively). Progression-free survival and OS rates were 74% (20/27) and 72%, respectively, at 26 weeks. Thirty percent of subjects were able to stop or reduce steroid usage by 12 weeks after surgery. Median KPS score, quality of life, and neurocognitive results did not change significantly for either group over the duration of survival. Adverse events were also similar for the two groups, with no significant difference in the overall event rate. There was a 12-week PFS and OS advantage for the radiation necrosis patients compared with the recurrent tumor or tumor progression patients. CONCLUSIONS In this study, in which enrolled patients had few alternative options for salvage treatment, LITT ablation stabilized the KPS score, preserved quality of life and cognition, had a steroid-sparing effect, and was performed safely in the majority of cases. Clinical trial registration no.: NCT01651078 (clinicaltrials.gov).

show abstract

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Laser ablation after stereotactic radiosurgery: a multicenter prospective study in patients with metastatic brain tumors and radiation necrosis

Ahluwalia

Barnett

Deng

et al. 2019

Journal of Neurosurgery

133

109

View full text Add to dashboard Cite

show abstract

“…The studies discussed in this review comprise only biopsy-confirmed cases of RN. However, many have argued that recurrent lesions after prior SRS for brain metastases may represent a mixture of both radiation necrosis and recurrent tumor pathologies, subject to local sampling bias and thus minimizing the diagnostic accuracy of intraoperative biopsy [41][42][43]. While the aforementioned studies suggest LITT may result in similar peri-procedural outcomes in terms of overall symptom improvement and steroid weaning, the underlying pathology has significant implications.…”

Section: Discussionmentioning

confidence: 99%

Laser interstitial thermal therapy for treatment of cerebral radiation necrosis

Hong

Beckta

Kundishora

et al. 2020

International Journal of Hyperthermia

View full text Add to dashboard Cite

Radiation necrosis is a well described complication after radiosurgical treatment of intracranial pathologiesbest recognized after the treatment of patients with arteriovenous malformations and brain metastases but possibly also affecting patients treated with radiosurgery for meningioma. The pathophysiology of radiation necrosis is still not well understood but is most likely a secondary local tissue inflammatory response to brain tissue injured by radiation. Radiation necrosis in brain metastases patients may present radiographically and behave clinically like recurrent tumor. Differentiation between radiation necrosis and recurrent tumor has been difficult based on radiographic changes alone. Biopsy or craniotomy therefore remains the gold standard method of diagnosis. For symptomatic patients, corticosteroids are first-line therapy, but patients may fail medical management due to intolerance of chronic steroids or persistence of symptoms. In these cases, open surgical resection has been shown to be successful in management of surgically amenable lesions but may be suboptimal in patients with deep-seated lesions or extensive prior cranial surgical history, both carrying high risk for peri-operative morbidity. Laser interstitial thermal therapy has emerged as a viable, alternative surgical option. In addition to allowing access to tissue for diagnosis, thermal treatment of the lesion can also be delivered precisely and accurately under real-time imaging guidance. This review highlights the pertinent studies that have shaped the impetus for use of laser interstitial thermal therapy in the treatment of radiation necrosis, reviewing indications, outcomes, and nuances toward successful application of this technology in patients with suspected radiation necrosis.

show abstract

“…While traditionally the workflow for LITT involved stereotactic placement of the laser in the OR and then either patient transfer to an MRI scanner 4 or utilization of intraoperative MRI, 16 we believe there are advantages to performing the entire procedure in the MRI suite. We examined our initial institutional experience with the realtime MRI system for laser amygdalohippocampal ablation and found that the initial learning curve can be quickly mastered.…”

Section: Discussionmentioning

confidence: 99%

Improved operative efficiency using a real-time MRI-guided stereotactic platform for laser amygdalohippocampotomy

Ho¹,

Sussman²,

Pendharkar³

et al. 2018

Journal of Neurosurgery

View full text Add to dashboard Cite

OBJECTIVE MR-guided laser interstitial thermal therapy (MRgLITT) is a minimally invasive method for thermal destruction of benign or malignant tissue that has been used for selective amygdalohippocampal ablation for the treatment of temporal lobe epilepsy. The authors report their initial experience adopting a real-time MRI-guided stereotactic platform that allows for completion of the entire procedure in the MRI suite. METHODS Between October 2014 and May 2016, 17 patients with mesial temporal sclerosis were selected by a multidisciplinary epilepsy board to undergo a selective amygdalohippocampal ablation for temporal lobe epilepsy using MRgLITT. The first 9 patients underwent standard laser ablation in 2 phases (operating room [OR] and MRI suite), whereas the next 8 patients underwent laser ablation entirely in the MRI suite with the ClearPoint platform. A checklist specific to the real-time MRI-guided laser amydalohippocampal ablation was developed and used for each case. For both cohorts, clinical and operative information, including average case times and accuracy data, was collected and analyzed. RESULTS There was a learning curve associated with using this real-time MRI-guided system. However, operative times decreased in a linear fashion, as did total anesthesia time. In fact, the total mean patient procedure time was less in the MRI cohort (362.8 ± 86.6 minutes) than in the OR cohort (456.9 ± 80.7 minutes). The mean anesthesia time was significantly shorter in the MRI cohort (327.2 ± 79.9 minutes) than in the OR cohort (435.8 ± 78.4 minutes, p = 0.02). CONCLUSIONS The real-time MRI platform for MRgLITT can be adopted in an expedient manner. Completion of MRgLITT entirely in the MRI suite may lead to significant advantages in procedural times.

show abstract

Intraoperative real-time MRI-guided stereotactic biopsy followed by laser thermal ablation for progressive brain metastases after radiosurgery

Cited by 15 publications

References 20 publications

Laser ablation after stereotactic radiosurgery: a multicenter prospective study in patients with metastatic brain tumors and radiation necrosis

Laser ablation after stereotactic radiosurgery: a multicenter prospective study in patients with metastatic brain tumors and radiation necrosis

Laser interstitial thermal therapy for treatment of cerebral radiation necrosis

Improved operative efficiency using a real-time MRI-guided stereotactic platform for laser amygdalohippocampotomy

Contact Info

Product

Resources

About