The Role of Laser-Induced Thermal Therapy in the Management of Malignant Gliomas

Abstract

Gliomas are the most common primary CNS malignancies, the vast majority of which are resistant high-grade malignant entities that require aggressive treatment with the combination of surgical resection, radiation, and chemotherapy (Neuro-Oncology. 2014;16:iv1–63). Prognoses for patients with unresectable newly diagnosed and recurrent high-grade gliomas remain dismal, and new approaches are required. Laser interstitial thermal therapy (LITT) is a rapidly developing minimally invasive technique that delivers thermal therapy into the tumor cavity under MRI guidance causing tumor ablation by inducing coagulation necrosis. This technique currently seems to be most beneficial in patients who are either poor surgical candidates or whose lesions are difficult to access—such as those located in the corpus callosum, insula, or the deep gray nuclei including the basal ganglia and the thalamus—where standard surgical approaches could result in significant morbidity. Currently, the literature suggests that survival following ablation with LITT can be equivalent to surgical resection both at initial diagnosis and recurrence. Further, several smaller studies now suggest that laser thermal ablation may result in improved survival in those who otherwise would be only eligible for biopsy at time of de novo diagnosis. Given that complications following use of LITT can affect as many as one-third of treated patients, larger, multicenter studies are still needed to confirm these findings and to fully identify the role of LITT in the overall treatment algorithm for patients with high-grade gliomas.