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Photonics & Lasers in Medicine


CiteScore 2016: 0.64

SCImago Journal Rank (SJR) 2016: 0.230
Source Normalized Impact per Paper (SNIP) 2016: 0.291

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2193-0643
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Prognostic factors of overall survival after laser interstitial thermal therapy in patients with glioblastoma

Prognostische Faktoren des Gesamtüberlebens nach interstitieller Laser-Thermotherapie bei Patienten mit Glioblastom

Symeon Missios
  • Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Department of Neurosurgery, Neurological and Taussig Cancer Institutes, Cleveland Clinic, 9500 Euclid Ave. S73, Cleveland, OH, USA
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Jason L. Schroeder
  • Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Department of Neurosurgery, Neurological and Taussig Cancer Institutes, Cleveland Clinic, 9500 Euclid Ave. S73, Cleveland, OH, USA
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Gene H. Barnett
  • Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Department of Neurosurgery, Neurological and Taussig Cancer Institutes, Cleveland Clinic, 9500 Euclid Ave. S73, Cleveland, OH, USA
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Alireza M. Mohammadi
  • Corresponding author
  • Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Department of Neurosurgery, Neurological and Taussig Cancer Institutes, Cleveland Clinic, 9500 Euclid Ave. S73, Cleveland, OH, USA
  • Email
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
Published Online: 2013-12-03 | DOI: https://doi.org/10.1515/plm-2013-0051

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.

Keywords: LITT; NeuroBlate® System; glioblastoma; laser ablation

Schlüsselwörter: LITT; NeuroBlate®-System; Glioblastom; Laserablation.

References

  • [1]

    Lacroix M, Abi-Said D, Fourney DR, Gokaslan ZL, Shi W, DeMonte F, Lang FF, McCutcheon IE, Hassenbusch SJ, Holland E, Hess K, Michael C, Miller D, Sawaya R. A multivariate analysis of 416 patients with glioblastoma multiforme: prognosis, extent of resection, and survival. J Neurosurg 2001;95(2):190–8.Google Scholar

  • [2]

    Sanai N, Polley MY, McDermott MW, Parsa AT, Berger MS. An extent of resection threshold for newly diagnosed glioblastomas. J Neurosurg 2011;115(1):3–8.Web of ScienceCrossrefGoogle Scholar

  • [3]

    Stupp R, Mason WP, van den Bent MJ, Weller M, Fisher B, Taphoorn MJ, Belanger K, Brandes AA, Marosi C, Bogdahn U, Curschmann J, Janzer RC, Ludwin SK, Gorlia T, Allgeier A, Lacombe D, Cairncross JG, Eisenhauer E, Mirimanoff RO; European Organisation for Research and Treatment of Cancer Brain Tumor and Radiotherapy Groups; National Cancer Institute of Canada Clinical Trials Group. Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med 2005;352(10):987–96.Google Scholar

  • [4]

    Stummer W, Pichlmeier U, Meinel T, Wiestler OD, Zanella F, Reulen HJ; ALA-Glioma Study Group. Fluorescence-guided surgery with 5-aminolevulinic acid for resection of malignant glioma: a randomised controlled multicentre phase III trial. Lancet Oncol 2006;7(5):392–401.Google Scholar

  • [5]

    Stummer W, Reulen HJ, Meinel T, Pichlmeier U, Schumacher W, Tonn JC, Rohde V, Oppel F, Turowski B, Woiciechowsky C, Franz K, Pietsch T; ALA-Glioma Study Group. Extent of resection and survival in glioblastoma multiforme: identification of and adjustment for bias. Neurosurgery 2008;62(3):564–76; discussion 564–76.CrossrefGoogle Scholar

  • [6]

    Barnett GH. The role of image-guided technology in the surgical planning and resection of gliomas. J Neurooncol 1999;42(3):247–58.CrossrefGoogle Scholar

  • [7]

    Senft C, Bink A, Franz K, Vatter H, Gasser T, Seifert V. Intraoperative MRI guidance and extent of resection in glioma surgery: a randomised, controlled trial. Lancet Oncol 2011;12(11):997–1003.CrossrefWeb of ScienceGoogle Scholar

  • [8]

    Barker 2nd FG, Chang SM, Gutin PH, Malec MK, McDermott MW, Prados MD, Wilson CB. Survival and functional status after resection of recurrent glioblastoma multiforme. Neurosurgery 1998;42(4):709–20; discussion 720–3.CrossrefGoogle Scholar

  • [9]

    Chen AM, Chang S, Pouliot J, Sneed PK, Prados MD, Lamborn KR, Malec MK, McDermott MW, Berger MS, Larson DA. Phase I trial of gross total resection, permanent iodine-125 brachytherapy, and hyperfractionated radiotherapy for newly diagnosed glioblastoma multiforme. Int J Radiat Oncol Biol Phys 2007;69(3):825–30.Web of ScienceGoogle Scholar

  • [10]

    Sneed PK, Stauffer PR, McDermott MW, Diederich CJ, Lamborn KR, Prados MD, Chang S, Weaver KA, Spry L, Malec MK, Lamb SA, Voss B, Davis RL, Wara WM, Larson DA, Phillips TL, Gutin PH. Survival benefit of hyperthermia in a prospective randomized trial of brachytherapy boost +/- hyperthermia for glioblastoma multiforme. Int J Radiat Oncol Biol Phys 1998;40(2):287–95.CrossrefGoogle Scholar

  • [11]

    Ulm 3rd AJ, Friedman WA, Bradshaw P, Foote KD, Bova FJ. Radiosurgery in the treatment of malignant gliomas: the University of Florida experience. Neurosurgery 2005;57(3):512–7; discussion 512–7.CrossrefGoogle Scholar

  • [12]

    Bown SG. Phototherapy in tumors. World J Surg 1983;7(6):700–9.CrossrefGoogle Scholar

  • [13]

    De Poorter J. Noninvasive MRI thermometry with the proton resonance frequency method: study of susceptibility effects. Magn Reson Med 1995;34(3):359–67.CrossrefGoogle Scholar

  • [14]

    Sloan AE, Ahluwalia MS, Valerio-Pascua J, Manjila S, Torchia MG, Jones SE, Sunshine JL, Phillips M, Griswold MA, Clampitt M, Brewer C, Jochum J, McGraw MV, Diorio D, Ditz G, Barnett GH. Results of the NeuroBlate System first-in-humans Phase I clinical trial for recurrent glioblastoma: clinical article. J Neurosurg 2013;118(6):1202–19.CrossrefWeb of ScienceGoogle Scholar

  • [15]

    Schwarzmaier HJ, Eickmeyer F, von Tempelhoff W, Fiedler VU, Niehoff H, Ulrich SD, Yang Q, Ulrich F. MR-guided laser-induced interstitial thermotherapy of recurrent glioblastoma multiforme: preliminary results in 16 patients. Eur J Radiol 2006;59(2):208–15.CrossrefGoogle Scholar

  • [16]

    Sugiyama K, Sakai T, Fujishima I, Ryu H, Uemura K, Yokoyama T. Stereotactic interstitial laser-hyperthermia using Nd-YAG laser. Stereotact Funct Neurosurg 1990;54–55:501–5.Google Scholar

  • [17]

    Kahn T, Bettag M, Ulrich F, Schwarzmaier HJ, Schober R, Fürst G, Mödder U. MRI-guided laser-induced interstitial thermotherapy of cerebral neoplasms. J Comput Assist Tomogr 1994;18(4):519–32.CrossrefGoogle Scholar

  • [18]

    Bettag M, Ulrich F, Schober R, Fürst G, Langen KJ, Sabel M, Kiwit JC. Stereotactic laser therapy in cerebral gliomas. Acta Neurochir Suppl (Wien) 1991;52:81–3.Google Scholar

  • [19]

    Reimer P, Bremer C, Horch C, Morgenroth C, Allkemper T, Schuierer G. MR-monitored LITT as a palliative concept in patients with high grade gliomas: preliminary clinical experience. J Magn Reson Imaging 1998;8(1):240–4.CrossrefGoogle Scholar

  • [20]

    Sanai N, Berger MS. Glioma extent of resection and its impact on patient outcome. Neurosurgery 2008;62(4):753–64.Web of ScienceCrossrefGoogle Scholar

About the article

Corresponding author: Alireza M. Mohammadi, Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Department of Neurosurgery, Neurological and Taussig Cancer Institutes, Cleveland Clinic, 9500 Euclid Ave. S73, Cleveland, OH, USA, e-mail:


Received: 2013-10-13

Accepted: 2013-11-06

Published Online: 2013-12-03

Published in Print: 2014-04-01


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.


Citation Information: Photonics & Lasers in Medicine, Volume 3, Issue 2, Pages 143–150, ISSN (Online) 2193-0643, ISSN (Print) 2193-0635, DOI: https://doi.org/10.1515/plm-2013-0051.

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