Introduction: Enhancing lesions that demonstrate progression after radiosurgery for metastatic brain tumors are often tumor recurrence or radiation necrosis. Magnetic resonance-guided laser-induced thermal therapy (LITT) is a minimally-invasive treatment option for postradiosurgery recurrence or radiation necrosis. We report the largest prospective series to date of LITT for the treatment of recurrent enhancing lesions after radiosurgery for brain metastases.
Methods: Patients with recurrent metastatic intracranial tumors or radiation necrosis who had previously undergone radiosurgery and had a Karnofsky performance status of >70 were eligible for LITT. The primary endpoint was local control using MR scans at intervals of >4 weeks. Additionally, we report overall survival, perioperative complications, and 30-day readmission rates.
Results: 30 patients (ages 46-90 years) who underwent 36 procedures for placement of 40 lasers in 39 enhancing lesions were available for follow-up. The mean pre-procedure lesion size measured 3.45 cm3 (range 0.23-10.52 cm3). At a median follow-up of 42.7 weeks (range 4.9-181.9 weeks), local control was 74.4% (30 of 39 lesions), and overall survival at 6, 12, 18, and 24 months was 83.3%, 46.9%, 23.3%, and 13.3%, respectively. 11 perioperative complications were encountered: 2 patients with known seizure disorders seized, 1 patient who underwent 2 procedures on different dates developed confusion in both instances, 4 patients had new or increased extremity motor weakness, 1 patient developed aphasia, 1 patient reported visual hallucinations, and 1 patient developed a facial nerve palsy. 6 patients were readmitted to the hospital within 30-days of the LITT procedure: 2 patients with known seizure disorder after seizing, 1 patient for atrial fibrillation with rapid ventricular rate, 2 patients with abdominal pain found to have ileus, and 1 patient for altered mental status. There were no procedure-related mortalities.
Conclusions: LITT is an effective and safe treatment option for local control of recurrent metastatic brain disease that has failed radiosurgery.
Patient Care: Our research aims to report long-term outcomes of LITT in patients with recurrent metastatic brain disease that has failed radiosurgery in order to provide neurosurgeons with an additional minimally-invasive treatment option for such patients.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Identify brain lesions appropriate for LITT, 2) Discuss local control of recurrent brain metastasis or radiation necrosis with LITT, 3) Discuss the safety and complications of LITT, 4) Identify a treatment option for patients with recurrent metastatic disease that has failed radiosurgery