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Laser interstitial thermal therapy for newly diagnosed glioblastoma

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Abstract

Gliomas are the most frequent primary brain tumor in adults. Patients with glioblastoma (GBM) tumors deemed inoperable with open surgical techniques and treated only with chemo/radiation have a median overall survival of less than 9 months. Laser interstitial thermal therapy (LITT) has emerged as a cytoreductive alternative to surgery for these patients. The present study describes the outcomes of twenty patients with newly diagnosed, IDH wild-type glioblastoma treated with LITT. We retrospectively reviewed patients with newly diagnosed, unresectable GBM who underwent LITT at our institution. Progression-free survival (PFS) was the primary endpoint measured in our study, defined as time from LITT to disease progression. Results Twenty patients were identified with newly diagnosed, inoperable GBM lesions who underwent LITT. The overall median PFS was 4 months (95% CI = 2 — N/A, upper limit not reached). The median progression-free survival (PFS) for patients with less than 1 cm 3 residual tumor (gross total ablation, GTA) was 7 months (95% CI = 6 — N/A, upper limit not reached), compared to 2 months (95% CI = 1 — upper limit not reached) for patients with a lower GTA (p = .0019). The median overall survival was 11 months (95% CI = 6 — upper limit not reached). Preoperative Karnofsky performance score (KPS) less than or equal to 80 and deep-seated tumor location were significantly associated with decreased PFS (HR, .18, p = .03; HR, .08, p = .03, respectively). At the end of 1 month, only 4 patients (20%) experienced persistent motor deficits. LITT is a safe and effective treatment for patients with unresectable, untreated GBM with rates of survival and local recurrence comparable to patients with surgically accessible lesions treated with conventional resection. Careful patient selection is needed to determine if GTA is attainable.

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Abbreviations

GBM:

Glioblastoma

LITT:

Laser interstitial thermal therapy

MR:

Magnetic resonance

IRB:

Institutional review board

KPS:

Karnofsky performance scale

FLAIR:

Fluid-attenuated inversion recovery

GTA:

Gross total ablation

PFS:

Progression-free survival

OS:

Overall survival

GTR:

Gross total resection

LOESS:

Locally weighted scatterplot smoothing

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Correspondence to Matthew Muir.

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Our study was approved by the institutional review board (IRB) at our institution with regard to the study of human subjects and consent was obtained for all described procedures.

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Muir, M., Patel, R., Traylor, J.I. et al. Laser interstitial thermal therapy for newly diagnosed glioblastoma. Lasers Med Sci 37, 1811–1820 (2022). https://doi.org/10.1007/s10103-021-03435-6

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