Abstract
Laser interstitial thermal therapy (LITT) offers a minimally invasive approach to the treatment of both regrowth of brain metastases and/or radiation necrosis following radiosurgery (known together as metastatic in-field recurrence). Current indications for LITT include patients who have KPS >70, have good expected survival or systemic therapy options, and are deemed suitable surgical candidates. While LITT treatment was previously offered when patients required initiation of steroids for symptom management, LITT results have been shown to be better when the lesion is smaller and therefore there is a current trend toward using LITT earlier in the course of the progression of these lesions. While surgical access is less invasive, adverse neurological outcomes following LITT are similar to those encountered in a craniotomy.
Post-LITT imaging changes can be variable but generally follow a trend of an initial increase in the size of contrast-enhanced volume followed by a steady decrease over the subsequent 3–6 months. Surprisingly, FLAIR volumes often do not increase but rather can decrease rapidly in some cases and is often associated with the ability to wean steroids. With regard to clinical outcomes, recent multicenter prospective series suggest worthwhile short-term progression-free survival rates for LITT, with better outcomes for patients with radiation necrosis as opposed to tumor regrowth. LITT also resulted in an improvement in neurological outcomes and preservation of KPS in many patients. Pilot data suggest that LITT may serve as an alternative to a craniotomy in these patients and additional benefit may be a result of disruption of the blood-brain barrier by the LITT procedure, thus potentially having implications on post-LITT therapeutic management. Larger prospective studies with longer-term follow-up are needed to further refine the indications for LITT and clarify its role in the cancer survivor.
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Abbreviations
- BBB:
-
blood-brain barrier
- BSE:
-
brain-specific enolase
- HVLT-R:
-
Hopkins Verbal Learning Test-Revised
- ICH:
-
intracerebral hemorrhage
- KPS:
-
Karnofsky Performance Score
- LAASR:
-
Laser Ablation After Stereotactic Radiosurgery study [5]
- LITT:
-
laser interstitial thermal therapy
- MMSE:
-
Mini-Mental State Examination
- MRI:
-
magnetic resonance imaging
- N/A:
-
not available
- PFS:
-
progression-free survival
- POD:
-
progression of disease
- QOL:
-
quality of life
- RN:
-
radiation necrosis
- SF-36:
-
Short-Form Health Survey
- SRS:
-
stereotactic radiosurgery
- TR:
-
tumor regrowth
- WBRT:
-
whole brain radiation therapy
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Sujijantarat, N., Danish, S.F., Chiang, V.L. (2020). LITT for Metastatic In-Field Recurrence. In: Chiang, V., Danish, S., Gross, R. (eds) Laser Interstitial Thermal Therapy in Neurosurgery. Springer, Cham. https://doi.org/10.1007/978-3-030-48047-9_5
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