Prognostic factors of overall survival after laser interstitial thermal therapy in patients with glioblastoma
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Symeon Missios
Abstract
Background:
Laser interstitial thermal therapy (LITT) is a minimally invasive technique for treating intracranial tumors percutaneously. Controlled thermal damage to the tumor may offer an adjunct to the treatment of glioblastoma multiforme (GBM) especially in deep-seated locations. We report our series of patients with GBM treated with LITT.
Methods:
Eleven consecutive patients with GBM who underwent LITT at the Cleveland Clinic using the NeuroBlate® System were retrospectively reviewed. The extent of tumor treatment was determined using thermal-damage-threshold (TDT) lines: yellow TDT-line (reached by heating tissue to at least 43°C for 2 min) and blue TDT-line (43°C for 10 min). Volumetric analysis was performed to determine the extent of coverage of tumor volume by the TDT-lines. Kaplan-Meier curves and Cox regression analysis were used to evaluate patient outcomes.
Results:
LITT was delivered as upfront treatment in six cases and delivered as salvage in five cases. After 26.2 months of follow-up, 73% of cases demonstrated progression and 54.5% died. The median overall survival (OS) for the cohort was 8.4 months. Median progression free survival (PFS) was 6.1 months. A tendency towards improved overall survival was discovered in patients who had near complete coverage of tumor by blue and yellow TDT-lines.
Conclusions:
LITT can be used in a safe and effective manner for the treatment of patients with difficult to access GBM. Improved coverage of the tumor by the TDT-treatment lines has a tendency to improve patient overall survival.
Zusammenfassung
Hintergrund:
Die interstitielle Laser-Thermotherapie (LITT) ist ein minimal-invasives Verfahren zur perkutanen Behandlung von intrakraniellen Tumoren. Die kontrollierte thermische Schädigung des Tumorgewebes bietet eine ergänzende Therapieoption von Glioblastomen (Glioblastoma multiforme, GBM), insbesondere bei tief sitzenden Neoplasien. Wir berichten über unsere Serie von Patienten mit GBM, die mittels LITT behandelt wurden.
Methoden:
Untersucht wurden retrospektiv 11 konsekutive Patienten mit GBM, die an der Cleveland Clinic mit dem NeuroBlate®-System behandelt wurden. Die Ausdehnung der Tumorbehandlung wurde anhand der thermischen Schädigungsgrenzen (TDT-Linien) überwacht: gelbe TDT-Linie (erreicht durch Erhitzen des Gewebes auf mindestens 43°C für 2 Minuten) und blaue TDT-Linie (43°C für 10 Minuten). Um das Ausmaß der Überdeckung des Tumorvolumens durch die TDT-Linien zu bestimmen, wurde eine volumetrische Analyse durchgeführt. Kaplan-Meier-Kurven und Cox-Regression wurden verwendet, um die Behandlungsergebnisse auszuwerten.
Ergebnisse:
Die LITT wurde als Voraus- in sechs und als Salvage-Therapie in fünf Fällen angewendet. Nach 26,2 Monaten Follow-up zeigten 73% der Patienten eine Progression des Tumorwachstums, 54,5% waren verstorben. Das mediane Gesamtüberleben für die Kohorte lag bei 8,4 Monaten. Das mediane progressionsfreie Überleben betrug 6,1 Monate. Eine Tendenz zu einer verbesserten Überlebensrate wurde bei den Patienten festgestellt, bei denen der Tumor nahezu vollständig durch die blauen und gelben TDT-Linien abgedeckt wurde.
Schlussfolgerungen:
Die LITT kann auf sichere und effektive Weise für die Behandlung von Patienten verwendet werden, bei denen ein erschwerter Zugriff auf die GBM besteht. Eine verbesserte Abdeckung des Tumors durch die TDT-Behandlungslinien zeigt tendenziell ein verbessertes Patienten-Gesamtüberleben.
Conflict of interest statement: The corresponding author, Alireza Mohammad Mohammadi, declares no conflict of interest. First and second authors (Symeon Missios and Jason L. Schroeder) have no conflict of interest as well. Dr. Gene H. Barnett (3rd author) is consultant medical director of Monteris company.
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©2014 by Walter de Gruyter Berlin/Boston
Artikel in diesem Heft
- Frontmatter
- Editorial
- Laser interstitial thermal therapy (LITT) of the brain – Experiences and new indications
- Magazine section
- Snapshots
- Reviews
- Laser interstitial thermal therapy with and without MRI guidance for treatment of brain neoplasms – A systematic review of the literature
- Laser interstitial thermal therapy for treatment of post-radiosurgery tumor recurrence and radiation necrosis
- MRI-guided laser interstitial thermal therapy of intracranial tumors and epilepsy: State-of-the-art review and a case study from pediatrics
- Original contributions
- Percutaneous selective laser amygdalo-hippocampectomy (SLAH) for treatment of mesial temporal lobe epilepsy within an interventional MRI suite
- Interstitial laser irradiation of cerebral gliomas – neurobiological background, technique and typical results
- Prognostic factors of overall survival after laser interstitial thermal therapy in patients with glioblastoma
- Laser interstitial thermal therapy as a novel treatment modality for brain tumors in the thalamus and basal ganglia
- Preliminary research report
- Endoscopic fluorescence visualization of 5-ALA photosensitized central nervous system tumors in the neural tissue transparency spectral range
- Congress announcements
- 21st Annual Meeting of the Deutsche Gesellschaft für Lasermedizin (DGLM) e.V.
- Congresses 2014/2015
Artikel in diesem Heft
- Frontmatter
- Editorial
- Laser interstitial thermal therapy (LITT) of the brain – Experiences and new indications
- Magazine section
- Snapshots
- Reviews
- Laser interstitial thermal therapy with and without MRI guidance for treatment of brain neoplasms – A systematic review of the literature
- Laser interstitial thermal therapy for treatment of post-radiosurgery tumor recurrence and radiation necrosis
- MRI-guided laser interstitial thermal therapy of intracranial tumors and epilepsy: State-of-the-art review and a case study from pediatrics
- Original contributions
- Percutaneous selective laser amygdalo-hippocampectomy (SLAH) for treatment of mesial temporal lobe epilepsy within an interventional MRI suite
- Interstitial laser irradiation of cerebral gliomas – neurobiological background, technique and typical results
- Prognostic factors of overall survival after laser interstitial thermal therapy in patients with glioblastoma
- Laser interstitial thermal therapy as a novel treatment modality for brain tumors in the thalamus and basal ganglia
- Preliminary research report
- Endoscopic fluorescence visualization of 5-ALA photosensitized central nervous system tumors in the neural tissue transparency spectral range
- Congress announcements
- 21st Annual Meeting of the Deutsche Gesellschaft für Lasermedizin (DGLM) e.V.
- Congresses 2014/2015
