MR-guided laser-induced interstitial thermotherapy of recurrent glioblastoma multiforme: Preliminary results in 16 patients

Schwarzmaier, Hans‐Joachim; Eickmeyer, Frank; Tempelhoff, W. v.; Fiedler, Volkhard Ulrich; Niehoff, Hendrik; Ulrich, Slif D.; Yang, Qin; Frank, Ulrich

doi:10.1016/j.ejrad.2006.05.010

Cited by 149 publications

(112 citation statements)

References 25 publications

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“…Recent studies report about successful applications in brain metastases [23][24][25]. The recognized types and special neuropathological chances in thermal lesions may improve the understanding of the biological response and ablation range.…”

Section: Resultsmentioning

confidence: 99%

Interstitial laser irradiation of cerebral gliomas – neurobiological background, technique and typical results

Tempelhoff

Frank²,

Schwarzmaier³

2014

Photonics &Amp; Lasers in Medicine

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Background:The most common type of primary brain tumors are gliomas. For patients unsuitable for open microsurgery having been treated by radiochemotherapy, laser irradiation has proven to be an alternative palliative option. From summer 1997 until winter 2006 we performed about 60 laser-interstitial thermotherapy (LITT) treatments, starting with patients with large recurrent tumors who had no other therapeutic option. In the present article we report about the neurobiological background, the technique and our experience with LITT of cerebral gliomas.Materials and method:For laser irradiation we used a specially designed light guide (LITT standard applicator; Trumpf Medizintechnik, Umkirch, Germany). The tip of this light guide is a special optical diffuser which is characterized by a homogeneous spherical or ellipsoid emission profile. The light guide was introduced into an appropriate protective sheath (Somatex, Teltow, Germany). For the laser light source, we used a continuous wave 1064-nm Nd:YAG laser (mediLas fibertom 4060 N; Dornier MedTech, Weßling, Germany). Laser irradiation was performed under general anesthesia in a 0.5 T open configuration magnetic resonance (MR) system (Signa SP; General Electric, Milwaukee, WI, USA). Usually, the tip of the light guide was positioned in the center of the tumor using the built-in localization system (Flashpoint 3000; IGT, Boulder, CO, USA) in combination, where appropriate, with a specially designed navigation system (Localite™, Bonn, Germany). The position of the light guide was then controlled using multiplanar reconstructions of T1-weighted sequences. For near real-time control, temperature monitoring was performed using an experimental software package based on the temperature-dependent shift of the MR signal. Laser irradiation was ceased when the temperature monitoring revealed a steady state temperature profile within the heated tissue. Since 2008 we have used traditional stereotactic targeting and methionine positron emission tomography/computed tomography (MET-PET/CT) instead of the ‘open’ MR system for planning and follow-up in LITT of brain tumors.Results:We started the LITT treatment of gliomas in the early 1990s (benign gliomas in eloquent regions/not suitable for surgery). In 1997 we started to treat patients with recurrent gliobastomas/anaplastic gliomas. All of these patients had an increased survival in comparison to the natural course of recurrent glioblastomas. There were no procedure-related deaths or permanent neurological deficits. Two factors seem to be important for the overall success of the LITT procedure: 1) an early enrollment in the LITT therapy after diagnosis of a tumor recurrence, and 2) a corresponding smaller tumor mass at the beginning of the therapy.Conclusion:Cytoreduction by laser irradiation seems to be a promising option for patients suffering from gliomas.

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Section: Resultsmentioning

confidence: 99%

Interstitial laser irradiation of cerebral gliomas – neurobiological background, technique and typical results

Tempelhoff

Frank²,

Schwarzmaier³

2014

Photonics &Amp; Lasers in Medicine

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“…Four studies that evaluated LITT as salvage therapy for recurrent HGG reported an overall survival of 9-15 months posttreatment. 1,5,7,8 Although these promising data are similar to survival achieved with salvage surgery for HGG, it is impossible to control for the contribution of adjuvant chemotherapies to this outcome. Nevertheless, recurrence may represent a favorable context for LITT application, because patients in this cohort are often poor surgical candidates with focal disease.…”

mentioning

confidence: 89%

Editorial: Laser interstitial thermal therapy: an effective treatment for focally recurrent high grade glioma

Malone

Bruce²

2014

FOC

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Laser interstitial thermal therapy (LITT) is an emerging treatment modality in glioma therapy. The technology is most effectively applied in the treatment of deep-seated lesions that are difficult to access surgically without injury to eloquent neurological structures. The LITT treatment produces focal thermal ablation leading to tumor cytoreduction through tissue coagulation, necrosis, and cellular apoptosis. Historically, laser ablation techniques have been limited by an inability to assess ablation progress and parenchymal temperature during the course of treatment. Advances in MRI capabilities have overcome these limitations, leading to the reapplication of this technology for select intracranial pathological entities, with promising preliminary results.In this issue of Neurosurgical Focus, Hawasli and colleagues review the current literature on LITT for the treatment of high-grade gliomas (HGGs).3 This report underscores the variability in published outcomes following LITT for HGG. Radiographically, the reported reduction in tumor size on follow-up imaging after LITT varies between 15% and 87% of total lesion volume.2,4 The average progression-free survival post-LITT ranges from 1 to 17 months, while overall survival post-LITT varies from 7 to 30 months.3 This variability may in part be attributed to mixed patient cohorts, including both newly diagnosed and recurrent tumors.Treatment results appear more consistent when limited to patients with disease recurrence, although this subgroup analysis is not available in all trials. Four studies that evaluated LITT as salvage therapy for recurrent HGG reported an overall survival of 9-15 months posttreatment. 1,5,7,8 Although these promising data are similar to survival achieved with salvage surgery for HGG, it is impossible to control for the contribution of adjuvant chemotherapies to this outcome. Nevertheless, recurrence may represent a favorable context for LITT application, because patients in this cohort are often poor surgical candidates with focal disease. Data from subgroup analysis of patients treated for newly diagnosed HGG are scarce. The varying indications that led to LITT as de novo treatment in these instances further limit conclusions that can be drawn from these data.Consistent with the surgical literature on extent of resection in HGG, "extent of ablation" appears to be an important factor influencing both overall and progressionfree survival.6 Additionally, increasing the thermal dose appears to be associated with improved radiographic response and perhaps clinical outcome.2,8 Intuitively, dose escalation with more aggressive laser ablation will increase the risk profile associated with LITT, particularly with the propensity for blood vessels and ventricles to act as heat sinks. Hawasli and colleagues report an overall complication rate of 49% after pooling data in their review of 174 HGG cases. Although some of these complications are minor and transient, there were 4 reports of cerebral edema, 30 of neurological deficits, and 6 reports of inf...

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“…We started treating recurrent glioblastomas in 1997. In 2002 and 2006, we presented the method and our experiences with the treatment of benign and anaplastic gliomas [9,10]. Our recent work at the University of Cologne has been concerned with the use of PET scans in the planning and control of LITT in malignant, recurrent gliomas [11].…”

Section: Laser Interstitial Thermal Therapy (Litt) Of the Brain -Expementioning

confidence: 99%

“…Several important advantages of LITT, compared to other adjuvant methods, are obvious: -No known side effects -No limitation with respect to the patients' age and Karnofsky performance status (local anesthesia is possible) -Repeatable as often as indicated (without limitation of applied kJ), as soon as tumor recurrence occurs -Ideal for lesions in eloquent regions that are otherwise unsuitable for surgery -Indicated in benign and malignant tumors (and other lesions) -Blood-brain barrier is modulated/opened during, and for a defined period after LITT, so that the effect of chemotherapy might be improved [9,17] -Easily adaptable to size and shape of the lesion (several target applications in one session possible) [9,10,12] The purpose of this special issue is to give an overview of current developments, technical improvements and new indications for the use of LITT in the central nervous system -for example as a causal therapy in the treatment of epileptic seizures, even in children, or post-radiation lesions in gliomas as presented in this issue by various research groups [19][20][21].…”

Section: Laser Interstitial Thermal Therapy (Litt) Of the Brain -Expementioning

confidence: 99%

Laser interstitial thermal therapy (LITT) of the brain – Experiences and new indications

Tempelhoff

Frank²

2014

Photonics &Amp; Lasers in Medicine

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MR-guided laser-induced interstitial thermotherapy of recurrent glioblastoma multiforme: Preliminary results in 16 patients

Cited by 149 publications

References 25 publications

Interstitial laser irradiation of cerebral gliomas – neurobiological background, technique and typical results

Interstitial laser irradiation of cerebral gliomas – neurobiological background, technique and typical results

Editorial: Laser interstitial thermal therapy: an effective treatment for focally recurrent high grade glioma

Laser interstitial thermal therapy (LITT) of the brain – Experiences and new indications

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