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Stereotactic Laser Ablation (SLA) followed by consolidation stereotactic radiosurgery (cSRS) as treatment for brain metastasis that recurred locally after initial radiosurgery (BMRS): a multi-institutional experience

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Abstract

Introduction

The optimal treatment paradigm for brain metastasis that recurs locally after initial radiosurgery remains an area of active investigation. Here, we report outcomes for patients with BMRS treated with stereotactic laser ablation (SLA, also known as laser interstitial thermal therapy, LITT) followed by consolidation radiosurgery.

Methods

Clinical outcomes of 20 patients with 21 histologically confirmed BMRS treated with SLA followed by consolidation SRS and > 6 months follow-up were collected retrospectively across three participating institutions.

Results

Consolidation SRS (5 Gy × 5 or 6 Gy × 5) was carried out 16–73 days (median of 26 days) post-SLA in patients with BMRS. There were no new neurological deficits after SLA/cSRS. While 3/21 (14.3%) patients suffered temporary Karnofsky Performance Score (KPS) decline after SLA, no KPS decline was observed after cSRS. There were no 30-day mortalities or wound complications. Two patients required re-admission within 30 days of cSRS (severe headache that resolved with steroid therapy (n = 1) and new onset seizure (n = 1)). With a median follow-up of 228 days (range: 178–1367 days), the local control rate at 6 and 12 months (LC6, LC12) was 100%. All showed diminished FLAIR volume surrounding the SLA/cSRS treated BMRS at the six-month follow-up; none of the patients required steroid for symptoms attributable to these BMRS. These results compare favorably to the available literature for repeat SRS or SLA-only treatment of BMRS.

Conclusions

This multi-institutional experience supports further investigations of SLA/cSRS as a treatment strategy for BMRS.

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Data availability

Data will be made available upon request as deemed appropriate by the corresponding author.

Code availability

Not applicable.

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Funding

No funding was provided for this study.

Author information

Authors and Affiliations

  1. Department of Neurosurgery, University of Minnesota, Minneapolis, MN, USA

    Isabela Peña Pino, Jun Ma & Clark C. Chen

  2. Department of Neurosurgery, The Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA

    Yusuke S. Hori, Gene H. Barnett & Alireza M. Mohammadi

  3. Department of Neurosurgery, Yale University School of Medicine, and Yale Cancer Center, New Haven, CT, USA

    Elena Fomchenko & Veronica Chang

  4. Department of Radiation Oncology, University of Minnesota, Minneapolis, MN, USA

    Kathryn Dusenbery, Margaret Reynolds, Christopher Wilke & Jianling Yuan

  5. Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA

    Ethan Srinivasan, Matthew Grabowski & Peter Fecci

  6. Department of Medicine, Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis, MN, USA

    Evidio Domingo-Musibay & Naomi Fujioka

  7. Department of Neurosurgery, University of Minnesota Medical School, D429 Mayo Memorial Building, 420 Delaware St. S. E., MMC96, Minneapolis, MN, 55455, USA

    Clark C. Chen

Authors
  1. Isabela Peña Pino
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Contributions

JM, YH, EF, KD, MR, CW, JY, ES, MG, PF, EDM, NF, GHB, VC and AM collected data. IPP drafted the manuscript. CCC conceived the study, performed procedures reported, drafted the manuscript. All authors edited the final draft of the manuscript and provided critical review.

Corresponding author

Correspondence to Clark C. Chen.

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The authors do not have any conflicts of interest to report.

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This study was approved by the local IRB at each participating institution.

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Consent for data collection was waived as this was a retrospective study.

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Peña Pino, I., Ma, J., Hori, Y.S. et al. Stereotactic Laser Ablation (SLA) followed by consolidation stereotactic radiosurgery (cSRS) as treatment for brain metastasis that recurred locally after initial radiosurgery (BMRS): a multi-institutional experience. J Neurooncol 156, 295–306 (2022). https://doi.org/10.1007/s11060-021-03893-6

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