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Radical Laser Interstitial Thermal Therapy Ablation Volumes Increase Progression-Free Survival in Biopsy-Proven Radiation Necrosis
摘要： Radical Laser Interstitial Thermal Therapy Ablation Volumes Increase Progression-Free Survival in Biopsy-Proven Radiation Necrosis
关键词： oncology,brain tumor,radiation necrosis,brain metastasis,progression free survival,Laser interstitial thermal therapy,post-radiation treatment effects
更新于2025-09-16 10:30:52
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Dynamic Contrast-Enhanced MRI in Patients with Brain Metastases Undergoing Laser Interstitial Thermal Therapy: A Pilot Study
摘要： BACKGROUND AND PURPOSE: Tumor recurrence is difficult to predict in patients receiving laser ablation for intracranial malignancy. We assessed the efficacy of the initial area under the time-to-signal intensity curve at 60 seconds (iAUC60) from dynamic contrast-enhanced MR imaging in predicting progression-free survival in patients with brain metastases following laser interstitial thermal therapy. MATERIALS AND METHODS: The study population was a consecutive series of patients undergoing laser interstitial thermal therapy for brain metastases. Patient demographics including age, sex, tumor histology, and Karnofsky Performance Scale were collected prospectively. Preoperative, postoperative, and 1-month follow-up dynamic contrast-enhanced MRIs were analyzed. Values of iAUC60 were computed using a trapezoidal rule applied to the time history of contrast uptake over the first 60 seconds postenhancement. The change in iAUC60 (ΔiAUC60) was calculated by taking the difference between the values of iAUC60 from 2 time points. Pearson correlation coefficients were calculated between progression-free survival, defined as the time from laser interstitial thermal therapy to tumor recurrence, and iAUC60 or ΔiAUC60 values. RESULTS: Thirty-three cases of laser interstitial thermal therapy for 32 brain metastases in a cohort of 27 patients were prospectively analyzed. A significant relationship was observed between the values of iAUC60 from postoperative dynamic contrast-enhanced MR imaging and progression-free survival with Pearson correlation (P = .03) and Cox univariate analysis (P = .01). The relationship between preoperative and 1-month follow-up dynamic contrast-enhanced MR imaging was not significantly correlated with progression-free survival. Similarly, no statistically significant relationship was observed with ΔiAUC60 and progression-free survival between any time points. CONCLUSIONS: Progression-free survival is difficult to predict in patients undergoing laser interstitial thermal therapy for brain metastases due to confounding with posttreatment change. iAUC60 extracted from postoperative dynamic contrast-enhanced MR imaging shows promise for accurately prognosticating patients following this operative therapy.
关键词： Dynamic contrast-enhanced MRI,Progression-free survival,Laser interstitial thermal therapy,Brain metastases,iAUC60
更新于2025-09-12 10:27:22
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Laser Interstitial Thermal Therapy to the Posterior Fossa: Challenges and Nuances
摘要： Objective: Posterior fossa tumors are rare in adults and pose a challenge to treat due to the bony contour of the posterior fossa, complex anatomical structures including deep venous sinuses, and the proximity of the fourth ventricle and brain stem. We describe our experience with LITT for the management of brain metastases and radiation necrosis of the posterior fossa. Methods: We retrospectively analyzed 13 patients with metastases and radiation necrosis of the posterior fossa managed with LITT. Results: Thirteen patients with histopathologically-confirmed radiation necrosis (n = 5) and metastases (n = 8) of the posterior fossa underwent LITT. The median preoperative tumor and postoperative ablation cavity volume was 4.66 cm3 and 6.29 cm3, respectively. The median volume of the ablation cavity decreased to 2.90 cm3 at 9-month follow-up. The median volume of peritumoral edema was 12.25 cm3 which fell to a median 5.77 cm3 at one-month follow-up. Median progression-free survival was 7 months (range 3 – 14 months) from LITT. The mean overall survival (OS) was 40 months (range 2 – 49 months). There were no intraoperative complications. One patient experienced palsy of the seventh and eighth cranial nerves on follow-up, attributable to LITT. Conclusion: Lesions of the posterior fossa are challenging to treat given their proximity to the dura and venous sinuses. We demonstrate that LITT ablation may be a safe and feasible option for metastases and radiation necrosis of the posterior fossa. Larger studies are needed to confirm the efficacy of this approach.
关键词： Brain Metastases,Posterior Fossa,Deep-Seated Tumor,Laser Interstitial Thermal Therapy,Radiation Necrosis
更新于2025-09-12 10:27:22
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Understanding the Relationship Between Real-Time Thermal Imaging and Thermal Damage Estimate During Magnetic Resonance–Guided Laser Interstitial Thermal Therapy
摘要： Objectives: Magnetic Resonance-guided Laser Interstitial Thermal Therapy (MRgLITT) is a minimally invasive procedure that utilizes intraoperative magnetic resonance thermometry (MRT) to generate a thermal damage estimate (TDE) of the ablative area. This study compared areas produced by the MRT heat map to the system-generated TDE produced by the Visualase software. Methods: All ablations were performed using the Visualase MRI-Guided Laser Ablation System. MRT heat-map and TDE were quantified using MATLAB version R2014a. The TDE was compared to the summed area of the green, yellow, and red areas (HM63.9) and the summed area of the light blue, green, yellow, and red areas (HM50.4) produced by the MRT heat map. Results: 56 patients undergoing MRgLITT were examined. The mean TDE produced was 236 mm2 (SEM = 9.5). The mean HM63.9 was 231 mm2 (SEM = 8.7), and the mean HM50.4 was 370 mm2 (SEM = 12.8). There was no significant difference between the TDE and HM63.9 (p = 0.51) . There was a significant difference between TDE and HM50.4 (p < 0.001) and between HM63.9 and HM50.4 (p < 0.001). Conclusions: The system-generated TDE consistently remains contained within the boundaries of the MRT heat map. At standard factory settings, the TDE and the area produced within the periphery of the HM63.9 are similar in magnitude. The light blue portion of the MRT heat map may serve as an additional means of predicting when critical structures may be at risk during laser ablation if exposed to further thermal stress.
关键词： MRTI,Thermal ablation parameters,LITT,Laser interstitial thermal therapy,Magnetic resonance thermometry
更新于2025-09-11 14:15:04
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Laser interstitial thermal therapy in drug-resistant epilepsy
摘要： MRI-guided stereotactic laser interstitial thermal therapy (LiTT) has been utilized in the surgical treatment of discrete, small epileptogenic lesions. This review summarizes the current literature and addresses the clinical application of this technique. LiTT has the potential to reduce the morbidity and discomfort of epilepsy surgery. Review of data from retrospective, uncontrolled studies suggests that LiTT may offer benefit when treating drug-resistant epilepsy because of mesial temporal sclerosis, hypothalamic hamartoma, cavernous hemangioma, and small cortical dysplasias and malformations. It is now being offered as initial therapy in place of anterior temporal lobectomy in many centers, and a prospective study is underway to compare it with historical temporal lobectomy reports. LiTT appears promising and has potential for reduced morbidity and improved tolerability compared with open surgery. Studies must be done to compare efficacy and safety of LiTT with open surgery, and further investigation is needed to optimize this technique.
关键词： magnetic resonance-guided laser interstitial thermal therapy,epilepsy surgery,laser ablation,temporal lobe epilepsy,drug-resistant epilepsy
更新于2025-09-11 14:15:04
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Early economic evaluation of MRI-guided laser interstitial thermal therapy (MRgLITT) and epilepsy surgery for mesial temporal lobe epilepsy
摘要： Background MRI-guided laser interstitial thermal therapy (MRgLITT) is a new minimally invasive treatment for temporal lobe epilepsy (TLE), with limited effectiveness data. It is unknown if the cost savings associated with shorter hospitalization could offset the high equipment cost of MRgLITT. We examined the cost-utility of MRgLITT versus surgery for TLE from healthcare payer perspective, and the value of additional research to inform policy decision on MRgLITT. Methods We developed a microsimulation model to evaluate quality adjusted life years (QALYs), costs, and incremental cost-effectiveness ratio (ICER) of MRgLITT versus surgery in TLE, assuming life-time horizon and 1.5% discount rate. Model inputs were derived from the literature. We conducted threshold and sensitivity analyses to examine parameter uncertainties, and expected value of partial perfect information analyses to evaluate the expected monetary benefit of eliminating uncertainty on probabilities associated with MRgLITT. Results MRgLITT yielded 0.08 more QALYs and cost $7,821 higher than surgery, with ICER of $94,350/QALY. Influential parameters that could change model outcomes include probabilities of becoming seizure-free from disabling seizures state and returning to disabling seizures from seizure-free state 5 years after surgery and MRgLITT, cost of MRgLITT disposable equipment, and utilities of disabling seizures and seizure-free states of surgery and MRgLITT. The cost-effectiveness acceptability curve showed surgery was preferred in more than 50% of iterations. The expected monetary benefit of eliminating uncertainty for probabilities associated with MRgLITT was higher than for utilities associated with MRgLITT. Conclusions MRgLITT resulted in more QALYs gained and higher costs compared to surgery in the base-case. The model was sensitive to variations in the cost of MRgLITT disposable equipment. There is value in conducting more research to reduce uncertainty on the probabilities and utilities of MRgLITT, but priority should be given to research focusing on improving the precision of estimates on effectiveness of MRgLITT.
关键词： MRI-guided laser interstitial thermal therapy,epilepsy surgery,economic evaluation,TLE,temporal lobe epilepsy,cost-utility,MRgLITT
更新于2025-09-11 14:15:04