Jump to ContentJump to Main Navigation
Show Summary Details
More options …

Photonics & Lasers in Medicine

Online
ISSN
2193-0643
See all formats and pricing
More options …

Laser interstitial thermal therapy as a novel treatment modality for brain tumors in the thalamus and basal ganglia

Interstitielle Laser-Thermotherapie als neue Behandlungsmethode bei Hirntumoren im Thalamus und den Basalganglien

Jason L. Schroeder
  • Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological and Taussig Cancer Institutes, Department of Neurosurgery, Cleveland Clinic, 9500 Euclid Ave./S73, 44195 Cleveland, OH, USA
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Symeon Missios
  • Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological and Taussig Cancer Institutes, Department of Neurosurgery, Cleveland Clinic, 9500 Euclid Ave./S73, 44195 Cleveland, OH, USA
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Gene H. Barnett
  • Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological and Taussig Cancer Institutes, Department of Neurosurgery, Cleveland Clinic, 9500 Euclid Ave./S73, 44195 Cleveland, OH, USA
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Alireza Mohammad Mohammadi
  • Corresponding author
  • Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological and Taussig Cancer Institutes, Department of Neurosurgery, Cleveland Clinic, 9500 Euclid Ave./S73, 44195 Cleveland, OH, USA
  • Email
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
Published Online: 2013-12-20 | DOI: https://doi.org/10.1515/plm-2013-0053

Abstract

Introduction:

Deep-seated hemispheric brain tumors pose unique challenges for surgical treatment. These tumors are often considered inoperable and when surgery is undertaken significant, serious, morbidity and even mortality may complicate the outcome. Laser interstitial thermal therapy (LITT) is a minimally invasive alternative to traditional open surgery that affects tumor cell death by producing a zone of thermal tissue damage that can be monitored and controlled with the aid of real-time magnetic resonance thermography.

Subjects and methods:

A retrospective review of six patients treated with LITT at the Cleveland Clinic between 5/2011 and 8/2013 was performed. We evaluated clinical patient data and pre-, intra-, and post-operative magnetic resonance imaging (MRI) data for correlation.

Results:

Six patients were treated with a total of eight separate LITT procedures for their thalamic (n=5) or basal ganglia (n=1) tumors. All tumors were histologically malignant and five were primary tumors. Pre- and post-operative neurological deficits were recorded. The two patients that underwent multiple procedures were retreated for different reasons – one due to insufficient coverage and the other due to tumor recurrence. Sustained post-operative neurological deficits were observed after three procedures and one patient died within 2 days of surgery from a thalamic hemorrhage.

Conclusions:

LITT is a minimally invasive surgical treatment that can lead to successful ablation of tumors of the thalamus or basal ganglia. However, this treatment has the potential for neurological morbidity or even mortality and as such further studies are needed to evaluate the true risk vs. reward potential for LITT with regard to treating deep-seated tumors.

Zusammenfassung

Einleitung:

Tiefsitzende hemisphärische Gehirntumoren stellen eine besondere Herausforderung für die chirurgische Behandlung dar. Diese Tumoren werden häufig als inoperabel eingestuft. Wird eine Operation durchgeführt, so ist diese häufig mit einem schlechten Outcome durch die einhergehende hohe Morbidität und Mortalität verbunden. Die interstitielle Laser-Thermotherapie (LITT) stellt eine minimal-invasive Alternative zur traditionellen offenen Chirurgie dar. Bei diesem Verfahren werden die Tumorzellen mittels Wärme zerstört, wobei die Ausdehnung der thermischen Gewebeschädigungszone mit Hilfe der Echtzeit-Magnetresonanz-Thermographie überwacht und gesteuert werden kann.

Patienten und Methoden:

Die vorliegende Arbeit ist eine retrospektive Studie von 6 Patienten, die im Zeitraum 5/2011 bis 8/2013 an der Cleveland-Klinik mittels LITT behandelt wurden. Untersucht wurden die klinischen Patientendaten sowie prä-, intra- und post-operative MRT-Daten für die Korrelation.

Ergebnisse:

Sechs Patienten mit Tumoren des Thalamus (n=5) oder der Basalganglien (n=1) wurden in insgesamt 8 LITT-Sessions behandelt. Alle Tumoren waren histologisch maligne, fünf waren Primärtumoren. Es wurden pre- und post-operative neurologische Defizite festgestellt. Zwei Patienten unterzogen sich einer mehrfachen Behandlung: ein Patient aufgrund unzureichender Abdeckung und der andere wegen eines Rezidivs. Nach drei Behandlungsprozeduren wurden anhaltende post-operative neurologische Defizite beobachtet. Ein Patient verstarb innerhalb von zwei Tagen nach der Operation durch eine Blutung im Thalamus.

Schlussfolgerungen:

Die LITT ist eine minimal-invasive chirurgische Behandlung, die zu einer erfolgreichen Ablation von Tumoren des Thalamus oder der Basalganglien führen kann. Allerdings birgt diese Behandlung das Risiko für neurologische Morbidität bis hin zur Mortalität. Daher sind weitere Studien erforderlich, um das tatsächliche Risiko-Nutzen-Verhältnis der LITT in Bezug auf die Behandlung von tief liegenden Tumoren evaluieren zu können.

Keywords: LITT; thalamic tumor; basal ganglia; minimally invasive surgery; laser ablation; NeuroBlate®

Schlüsselwörter: LITT; Thalamustumor; Basalganglien; minimal-invasive Chirurgie; Laserablation; NeuroBlate®

References

  • [1]

    Dolecek TA, Propp JM, Stroup NE, Kruchko C. CBTRUS statistical report: primary brain and central nervous system tumors diagnosed in the United States in 2005–2009. Neuro Oncol 2012;14(Suppl 5):v1–49. doi: 10.1093/neuonc/nos218.CrossrefGoogle Scholar

  • [2]

    Ojemann JG, Miller JW, Silbergeld DL. Preserved function in brain invaded by tumor. Neurosurgery 1996;39(2):253–8; discussion 258–9.CrossrefGoogle Scholar

  • [3]

    Steck J, Friedman WA. Stereotactic biopsy of brainstem mass lesions. Surg Neurol 1995;43(6):563–7; discussion 567–8.CrossrefGoogle Scholar

  • [4]

    Moshel YA, Link MJ, Kelly PJ. Stereotactic volumetric resection of thalamic pilocytic astrocytomas. Neurosurgery 2007;61(1):66–75; discussion 75.CrossrefGoogle Scholar

  • [5]

    Kelly PJ. Stereotactic biopsy and resection of thalamic astrocytomas. Neurosurgery 1989;25(2):185–94; discussion 194–5.CrossrefGoogle Scholar

  • [6]

    Cheek WR, Taveras JM. Thalamic tumors. J Neurosurg 1966;24(2):505–13.CrossrefWeb of ScienceGoogle Scholar

  • [7]

    Beks JW, Bouma GJ, Journée HL. Tumours of the thalamic region. A retrospective study of 27 cases. Acta Neurochir (Wien) 1987;85(3–4):125–7.CrossrefGoogle Scholar

  • [8]

    Grigsby PW, Garcia DM, Simpson JR, Fineberg BB, Schwartz HG. Prognostic factors and results of therapy for adult thalamic and brainstem tumors. Cancer 1989;63(11):2124–9.CrossrefGoogle Scholar

  • [9]

    Steiger HJ, Götz C, Schmid-Elsaesser R, Stummer W. Thalamic astrocytomas: surgical anatomy and results of a pilot series using maximum microsurgical removal. Acta Neurochir (Wien) 2000;142(12):1327–36; discussion 1336–7.CrossrefGoogle Scholar

  • [10]

    Matsumoto K, Higashi H, Tomita S, Furuta T, Ohmoto T. Resection of deep-seated gliomas using neuroimaging for stereotactic placement of guidance catheters. Neurol Med Chir (Tokyo) 1995;35(3):148–55.CrossrefGoogle Scholar

  • [11]

    Krouwer HG, Prados MD. Infiltrative astrocytomas of the thalamus. J Neurosurg 1995;82(4):548–57.CrossrefGoogle Scholar

  • [12]

    Schwabe B, Kahn T, Harth T, Ulrich F, Schwarzmaier HJ. Laser-induced thermal lesions in the human brain: short- and long-term appearance on MRI. J Comput Assist Tomogr 1997;21(5):818–25.CrossrefGoogle Scholar

  • [13]

    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

  • [14]

    Carpentier A, Chauvet D, Reina V, Beccaria K, Leclerq D, McNichols RJ, Gowda A, Cornu P, Delattre JY. MR-guided laser-induced thermal therapy (LITT) for recurrent glioblastomas. Lasers Surg Med 2012;44(5):361–8.Web of ScienceCrossrefGoogle Scholar

  • [15]

    Jethwa PR, Barrese JC, Gowda A, Shetty A, Danish SF. Magnetic resonance thermometry-guided laser-induced thermal therapy for intracranial neoplasms: initial experience. Neurosurgery 2012;71(1 Suppl Operative):133–44; 144–5.Google Scholar

  • [16]

    Carpentier A, McNichols RJ, Stafford RJ, Itzcovitz J, Guichard JP, Reizine D, Delaloge S, Vicaut E, Payen D, Gowda A, George B. Real-time magnetic resonance-guided laser thermal therapy for focal metastatic brain tumors. Neurosurgery 2008;63(1 Suppl 1):ONS21–8; discussion ONS28–9.Google Scholar

  • [17]

    Carpentier A, McNichols RJ, Stafford RJ, Guichard JP, Reizine D, Delaloge S, Vicaut E, Payen D, Gowda A, George B. Laser thermal therapy: real-time MRI-guided and computer-controlled procedures for metastatic brain tumors. Lasers Surg Med 2011;43(10):943–50.Web of ScienceCrossrefGoogle Scholar

  • [18]

    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

  • [19]

    Menovsky T, Beek JF, Roux FX, Bown SG. Interstitial laser thermotherapy: developments in the treatment of small deep-seated brain tumors. Surg Neurol 1996;46(6):568–71; discussion 571–2.CrossrefGoogle Scholar

  • [20]

    Hawasli AH, Ray WZ, Murphy RK, Dacey RG Jr, Leuthardt EC. Magnetic resonance imaging-guided focused laser interstitial thermal therapy for subinsular metastatic adenocarcinoma: technical case report. Neurosurgery 2012;70(2 Suppl Operative):332–7; discussion 338.Google Scholar

  • [21]

    Jethwa PR, Lee JH, Assina R, Keller IA, Danish SF. Treatment of a supratentorial primitive neuroectodermal tumor using magnetic resonance-guided laser-induced thermal therapy. J Neurosurg Pediatr 2011;8(5):468–75.Web of ScienceCrossrefGoogle Scholar

About the article

Corresponding author: Alireza Mohammad Mohammadi, Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological and Taussig Cancer Institutes, Department of Neurosurgery, Cleveland Clinic, 9500 Euclid Ave./S73, 44195 Cleveland, OH, USA, e-mail:


Received: 2013-10-15

Revised: 2013-11-27

Accepted: 2013-12-03

Published Online: 2013-12-20

Published in Print: 2014-04-01


Citation Information: Photonics & Lasers in Medicine, Volume 3, Issue 2, Pages 151–158, ISSN (Online) 2193-0643, ISSN (Print) 2193-0635, DOI: https://doi.org/10.1515/plm-2013-0053.

Export Citation

©2014 by Walter de Gruyter Berlin/Boston.Get Permission

Citing Articles

Here you can find all Crossref-listed publications in which this article is cited. If you would like to receive automatic email messages as soon as this article is cited in other publications, simply activate the “Citation Alert” on the top of this page.

[1]
Ashish H Shah, Joshua D Burks, Simon S Buttrick, Luca Debs, Michael E Ivan, and Ricardo J Komotar
Neurosurgery, 2018
[2]
Sunil Manjila, Margherita Mencattelli, Benoit Rosa, Karl Price, Georgios Fagogenis, and Pierre E. Dupont
Neurosurgical Focus, 2016, Volume 41, Number 3, Page E13

Comments (0)

Please log in or register to comment.
Log in