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Magnetic Resonance-Guided Laser Ablation Improves Local Control for Postradiosurgery Recurrence and/or Radiation Necrosis

Rao, Malay S. MD, PharmD*; Hargreaves, Eric L. PhD; Khan, Atif J. MD*; Haffty, Bruce G. MD*; Danish, Shabbar F. MD

Neurosurgery:
doi: 10.1227/NEU.0000000000000332
Research-Human-Clinical Studies
Abstract

BACKGROUND: Enhancing lesions that progress after stereotactic radiosurgery are often tumor recurrence or radiation necrosis. Magnetic resonance-guided laser-induced thermal therapy (LITT) is currently being explored for minimally invasive treatment of intracranial neoplasms.

OBJECTIVE: To report the largest series to date of local control with LITT for the treatment of recurrent enhancing lesions after stereotactic 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. Sixteen patients underwent a total of 17 procedures. The primary end point was local control using magnetic resonance imaging scans at intervals of >4 weeks. Radiographic outcomes were followed up prospectively until death or local recurrence (defined as >25% increase in volume compared with the 24-hour postprocedural scan).

RESULTS: Fifteen patients (age, 46-82 years) were available for follow-up. Primary tumor histology was non–small-cell lung cancer (n = 12) and adenocarcinoma (n = 3). On average, the lesion size measured 3.66 cm3 (range, 0.46-25.45 cm3); there were 3.3 ablations per treatment (range, 2-6), with 7.73-cm depth to target (range, 5.5-14.1 cm), ablation dose of 9.85 W (range, 8.2-12.0 W), and total ablation time of 7.43 minutes (range, 2-15 minutes). At a median follow-up of 24 weeks (range, 4-84 weeks), local control was 75.8% (13 of 15 lesions), median progression-free survival was 37 weeks, and overall survival was 57% (8 of 14 patients). Two patients experience recurrence at 6 and 18 weeks after the procedure. Five patients died of extracranial disease progression; 1 patient died of neurological progression elsewhere in the brain.

CONCLUSION: Magnetic resonance imaging-guided LITT is a well-tolerated procedure and may be effective in treating tumor recurrence/radiation necrosis.

ABBREVIATIONS: FLAIR, fluid-attenuated inversion-recovery

LITT, laser-induced thermal therapy

RN, radiation-induced cerebral necrosis

SRS, stereotactic radiosurgery

Author Information

*Department of Radiation Oncology and

Neurosurgery, Rutgers University-Robert Wood Johnson Medical School, New Brunswick, New Jersey

Correspondence: Shabbar F. Danish, MD, Department of Neurosurgery, Rutgers University, Robert Wood Johnson Hospital, 1 RWJ Place New Brunswick, NJ 08903. E-mail: shabbar.danish@rutgers.edu

Received November 19, 2013

Accepted February 07, 2014

Copyright © by the Congress of Neurological Surgeons