The Role of Laser Interstitial Thermal Therapy in Surgical Neuro-Oncology: Series of 100 Consecutive Patients.

Abstract

Laser interstitial thermal therapy (LITT) is an adjuvant treatment for intracranial lesions that are treatment refractory or in deep or eloquent brain. Initial studies of LITT in surgical neuro-oncology are limited in size and follow-up. To present our series of LITT in surgical neuro-oncology to better evaluate procedural safety and outcomes. An exploratory cohort study of all patients receiving LITT for brain tumors by a single senior neurosurgeon at a single center between 2013 and 2018. Primary outcomes included extent of ablation (EOA), time to recurrence (TTR), local control at 1-yr follow-up, and overall survival (OS). Secondary outcomes included complication rate. Outcomes were compared by tumor subtype. Predictors of outcomes were identified. A total of 91 patients underwent 100 LITT procedures; 61% remain alive with 72% local control at median 7.2 mo follow-up. Median TTR and OS were 31.9 and 16.9 mo, respectively. For lesion subtypes, median TTR (months, not applicable [N/A] if <50% rate observed), local control rates at 1-yr follow-up, and median OS (months) were the following: dural-based lesions (n=4, N/A, 75%, 20.7), metastases (n=45, 55.9, 77.4%, 16.9), newly diagnosed glioblastoma (n=11, 31.9, 83.3%, 32.3), recurrent glioblastoma (n=14, 5.6, 24.3%, 7.3), radiation necrosis (n=20, N/A, 67.2%, 16.4), and other lesions (n=6, 12.3, 80%, 24.4). TTR differed by tumor subtype (P=.02, log-rank analysis). EOA predicted local control (P=.009, multivariate proportional hazards regression); EOA > 85% predicted longer TTR (P=.006, log-rank analysis). Complication rate was 4%. Our series of LITT in surgical neuro-oncology, 1 of the largest to date, further evidences its safety and outcomes profile.