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.

Isabela Peña Pino,Peter Fecci,Jun Ma,Kathryn Dusenbery,Veronica Chang,Matthew Grabowski,Margaret Reynolds,Yusuke S Hori,Naomi Fujioka,Christopher Wilke,Evidio Domingo-Musibay,Gene H Barnett,Alireza M Mohammadi,Ethan Srinivasan,Clark C Chen,Jianling Yuan,Elena Fomchenko

doi:10.1007/s11060-021-03893-6

Abstract

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. Clinical outcomes of 20 patients with 21 histologically confirmed BMRS treated with SLA followed by consolidation SRS and > 6months follow-up were collected retrospectively across three participating institutions. Consolidation SRS (5Gy × 5 or 6Gy × 5) was carried out 16-73days (median of 26days) 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 30days of cSRS (severe headache that resolved with steroid therapy (n = 1) and new onset seizure (n = 1)). With a median follow-up of 228days (range: 178-1367days), the local control rate at 6 and 12months (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. This multi-institutional experience supports further investigations of SLA/cSRS as a treatment strategy for BMRS.

Highlights

The optimal treatment paradigm for brain metastasis that recurs locally after initial radiosurgery (BMRS) remains an area of active investigation
While 3/21 (14.3%) patients suffered temporary Karnofsky Performance Score (KPS) decline after stereotactic laser ablation (SLA), no KPS declines was observed after consolidation radiosurgery (cSRS)
We previously reported results from four BMRS patients treated with SLA followed by cSRS in 2016 [13]

Summary

Introduction

The optimal treatment paradigm for brain metastasis that recurs locally after initial radiosurgery (BMRS) remains an area of active investigation. There is currently no consensus on the optimal treatment strategy for brain metastasis that recur after radiosurgery (BMRS). Repeat radiosurgery to BMRS is often employed in this context Such treatments are associated with an increased risk for neurologic decline secondary to adverse radiation effects, including radiation necrosis[7, 8]. These repeat radiation-associated deleterious effects can compromise the patient’s quality of life, delay systemic therapy, or necessitate surgical interventions [8, 9]. Up to 30% of repeat radiosurgery fail to achieve local control of BMRS [10]

Methods

Results

Conclusion