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Laser interstitial thermal therapy (LITT) vs. bevacizumab for radiation necrosis in previously irradiated brain metastases

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Abstract

Purpose

Both laser interstitial thermal therapy (LITT) and bevacizumab have been used successfully to treat radiation necrosis (RN) after radiation for brain metastases. Our purpose is to compare pre-treatment patient characteristics and outcomes between the two treatment options.

Methods

Single-institution retrospective chart review identified brain metastasis patients who developed RN between 2011 and 2018. Pre-treatment factors and treatment responses were compared between those treated with LITT versus bevacizumab.

Results

Twenty-five patients underwent LITT and 13 patients were treated with bevacizumab. The LITT cohort had a longer overall survival (median 24.8 vs. 15.2 months for bevacizumab, p = 0.003) and trended to have a longer time to local recurrence (median 12.1 months vs. 2.0 for bevacizumab), although the latter failed to achieve statistical significance (p = 0.091). LITT resulted in an initial increase in lesional volume compared to bevacizumab (p < 0.001). However, this trend reversed in the long term follow-up, with LITT resulting in a median volume decrease at 1 year post-treatment of − 64.7% (range − 96.0% to +  > 100%), while bevacizumab patients saw a median volume increase of +  > 100% (range − 63.0% to +  > 100%), p = 0.010.

Conclusions

Our study suggests that patients undergoing LITT for RN have longer overall survival and better long-term lesional volume reduction than those treated with bevacizumab. However, it remains unclear whether our findings are due only to a difference in efficacy of the treatments or the implications of selection bias.

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Abbreviations

KPS:

Karnofsky performance score

LITT:

Laser interstitial thermal therapy

OS:

Overall survival

PFS:

Progression-free survival

RN:

Radiation necrosis

SRS:

Stereotactic radiosurgery

WBRT:

Whole brain radiation therapy

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Authors and Affiliations

  1. Department of Neurosurgery, Yale University School of Medicine, 333 Cedar St, New Haven, CT, 06520, USA

    Nanthiya Sujijantarat, Christopher S. Hong, Aladine A. Elsamadicy, Joseph P. Antonios, Andrew B. Koo & Veronica L. Chiang

  2. Department of Pharmacy Services, Yale-New Haven Hospital, 20 York St, New Haven, CT, 06510, USA

    Kent A. Owusu

  3. Department of Neurology, Yale University School of Medicine, 333 Cedar St, New Haven, CT, 06520, USA

    Joachim M. Baehring

Authors
  1. Nanthiya Sujijantarat
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  2. Christopher S. Hong
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  3. Kent A. Owusu
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  4. Aladine A. Elsamadicy
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  5. Joseph P. Antonios
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  6. Andrew B. Koo
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  7. Joachim M. Baehring
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  8. Veronica L. Chiang
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Nanthiya Sujijantarat, MD, Christopher S. Hong, MD, Kent A. Owusu, PharmD, BCCCP, BCPS, Aladine A. Elsamadicy, MD, Joseph P. Antonios, MD, PhD, and Andrew B. Koo, MD. The first draft of the manuscript was written by Nanthiya Sujijantarat, MD, and edited by Veronica L. Chiang, MD and Joachim Baehring, MD. All authors commented on subsequent versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Veronica L. Chiang.

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Conflict of interest

The senior author of this paper (VC) is a consultant for Monteris Medical Inc. (Minnesota, USA) and Clearpoint Neuro (California, USA). No other authors have any conflicts of interest to disclose.

Ethics approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Sujijantarat, N., Hong, C.S., Owusu, K.A. et al. Laser interstitial thermal therapy (LITT) vs. bevacizumab for radiation necrosis in previously irradiated brain metastases. J Neurooncol 148, 641–649 (2020). https://doi.org/10.1007/s11060-020-03570-0

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  • DOI: https://doi.org/10.1007/s11060-020-03570-0

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