Laser Interstitial Thermal Therapy in Patients with Newly Diagnosed Glioblastoma: A Systematic Review

Abstract

Background: Laser interstitial thermal therapy (LITT) is a minimal invasive neurosurgical technique for the treatment of brain tumors. Results of LITT have been reported in a case series of patients with deep seated and/or recurrent glioblastoma or cerebral metastases. With this review we aim to summarize the currently available evidence regarding safety and effectiveness of LITT in patients with newly diagnosed glioblastoma (nGBM). Methods: A literature search was performed using electronic databases (PubMed and Embase). Papers were assessed for the methodological quality using the Risk Of Bias In Non- randomised Studies - of Interventions (ROBINS-I) tool, and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) was used to assess the quality of the evidence. Results: We identified 835 papers of which only 11 articles were eligible for our review. All papers suffered from serious or critical risk of bias, and the quality of evidence was graded as very low according to the GRADE criteria. None of the studies was randomized and reporting of confounders and other parameters was poor. Median overall survival (OS) ranged from 4.1 to 32 months and progression free survival (PFS) from 2 to 31 months. The mean complication rate was 33.7%. No quality of life or cost-effectiveness data were reported. Conclusions: Due to the low quality of the studies, it is not possible to draw firm conclusions regarding the (cost) effectiveness of LITT in patients with newly diagnosed glioblastoma. The low quality of evidence shows the need for a well-designed prospective multicenter randomized controlled trial.

The Impact of Extent of Ablation on Survival of Patients With Newly Diagnosed Glioblastoma Treated With Laser Interstitial Thermal Therapy: A Large Single-Institutional Cohort

“…Hence, knowing which patients will benefit most from LITT and to what extent is obscure. 4 Several studies exemplify the inconsistency of the available data. For example, Beaumont et al, 19 showed that EOA >90% improved the survival of 9 patients with corpus callosum ndGBM while Di et al, 12 showed that an EOA >70% increased the PFS of 20 patients with ndGBM.…”

“…1-3 Although its use has increased over the past few decades and safety repeatedly demonstrated, its role in treating patients with newly diagnosed glioblastoma multiforme (ndGBM) is not fully established, mainly because of small sample-size studies and confounding parameters. 4,5…”

“…[1][2][3] Although its use has increased over the past few decades and safety repeatedly demonstrated, its role in treating patients with newly diagnosed glioblastoma multiforme (ndGBM) is not fully established, mainly because of small sample-size studies and confounding parameters. 4,5 It is well-known that a maximal safe near-total resection of the enhancing tumor mass should be achieved to improve oncological treatment efficiency and patients' survival. 6,7 As LITT ablates tumor tissue, it may induce a similar effect.…”

“…2 This leads to a significant inconsistency of the data which were further highlighted in a recent literature review that summarized the overall survival (OS) reported in studies to range widely between 3.3 and 32.3 months. 4 Altogether, this precludes drawing practical conclusions regarding LITT's upfront effect on survival outcomes of patients with ndGBM.…”

Managing Central Nervous System Tumors During Pregnancy

“…75,76 This approach is also known as laser interstitial thermal therapy, stereotactic laser ablation, and MRI-guided laser ablation. 75,76 A 2021 review of the literature for effectiveness of this approach in newly diagnosed glioblastoma was inconclusive and noted the need for more well-designed prospective studies to generate conclusions. 76 No studies for this device that specifically included pregnant women have been reported.…”