Laser interstitial thermal therapy in neuro-oncology applications

Abstract

Background: Laser interstitial thermal therapy (LITT) is a minimally invasive surgical treatment for multiple intracranial pathologies that are of growing interest to neurosurgeons and their patients and is emerging as an effective alternative to standard of care open surgery in the neurosurgical armamentarium. This option was initially considered for those patients with medical comorbidities and lesion-specific characteristics that confer excessively high risk for resection through a standard craniotomy approach but indications are changing. Methods: The PubMed database was searched for studies in the English literature on LITT for the treatment of primary and metastatic brain tumors, meningiomas, as well as for radiation necrosis (RN) in previously irradiated brain tumors. Results: This review provides an update of the relevant literature regarding application of LITT in neurosurgical oncology for the treatment of de novo and recurrent primary gliomas and brain metastases radiographically regrowing after previous irradiation as recurrent tumor or RN. In addition, this review details the limited experience of LITT with meningiomas and symptomatic peritumoral edema after radiosurgery. The advantages and disadvantages, indications, and comparisons to standard of care treatments such as craniotomy for open surgical resection are discussed for each pathology. Finally, the literature on cost-benefit analyses for LITT are reviewed. Conclusion: The studies discussed in this review have helped define the role of LITT in neurosurgical oncology and delineate optimal patient selection and tumor characteristics most suitable to this intervention.

Laser Interstitial Thermal Therapy in a Large Thalamic Glioma with Long-Term Remission: A Case Report

“…Additionally, LITT may open the blood-brain barrier (BBB) for months, which may pave the way for better penetration of chemotherapeutic agents [6] and macrophage infiltration of the lesion [7]. Studies have demonstrated the efficacy of LITT for multiple indications, including brain metastasis, radiation necrosis, cavernous malformations, epilepsy, gliomas, and meningiomas [2,4,[6][7][8][9][10][11]. In high-grade glioma, complete ablation was associated with longer progression-free survival (PFS) in difficult-to-access regions of the brain [5].…”