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Laser interstitial thermal therapy in the treatment of brain metastases: the relationship between changes in postoperative magnetic resonance imaging characteristics and tumor recurrence

  • Original Article - Brain Tumors
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Abstract

Background

Laser interstitial thermal therapy (LITT) has been used to treat brain metastases (BMs) in several countries, and its safety and effectiveness have been confirmed. In most cases, magnetic resonance imaging (MRI) reveals an increase in tumor volume with an enhanced margin after LITT. However, little is known about the relationship between this MRI change and tumor recurrence.

Objective

We report the first case series of BMs treated by LITT in China to evaluate the clinical characteristics and predictive factors of tumor recurrence.

Material and methods

Patients with less than four brain metastatic lesions and a Karnofsky performance status (KPS) > 70 were eligible for study inclusion. Standard LITT procedures were performed, and a follow-up MRI was performed to analyze the radiographic changes, especially the volume ratio of the enhanced margin and the whole lesion on MRI at 30 days postoperatively. All the volume-related data were delineated and calculated using 3D Slicer software. Related predictors were also collected to evaluate the correlation with local tumor control.

Results

Eighteen patients with nineteen lesions were enrolled for treatment and follow-up. Primary tumor histology included pulmonary carcinoma (n = 11) and breast cancer (n = 4). On average, the tumor size measured 3.01 cm3 (range, 0.40–7.40 cm3), the total ablation time was 13.58 min (range, 2.88–37.15 min), and the complete ablation rate was 92.4% (range, 29.2–100%). Comparing 3s0-day follow-up MRI results with preoperative MRI findings, 18 lesions showed a 2.28-fold (range, 1.21–4.88) volume increase; all the lesions displayed an enhanced component with a volume ratio of 42.35% (range, 10.14–100%). Five patients experienced tumor recurrence, and the local tumor control rates at 90 days and 180 days of follow-up were 68.4% and 66.7%, respectively. Univariate analysis indicated that the primary tumor, ablation rate, and enhanced volume ratio (EVR) > 40% in the 30-day MRI were associated with tumor recurrence, whereas multivariate analysis showed that only EVR > 40% was a predictive factor of local control.

Conclusion

LITT is a minimally invasive method used to ablate brain metastases which can be used as the first-line treatment for BM patients under certain indications. After LITT, most tumors showed volume enlargement on the 30-day MRI scan, and EVR > 40% on the 30-day MRI may indicate late tumor recurrence.

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Data Availability

The datasets generated and/or analysed during the current study are not publicly available because it is used for further analysis, but are available from the corresponding author on reasonable request.

Abbreviations

BM:

Brain metastases

LITT:

Laser interstitial thermal therapy

SRS:

Stereotactic radiosurgery

MRI:

Magnetic resonance imaging

KPS:

Karnofsky performance status

CSF:

Cerebrospinal fluid

EVR:

Enhanced volume ratio

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Acknowledgements

This study was supported by grants from the National Natural Science Foundation of China (82003075), Beijing Tiantan Hospital Independent Program (HX-A-2022029), and Beijing Hospitals Authority Youth Program (QML20210502).

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Authors and Affiliations

  1. Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, 119 Nansihuan Xilu, Beijing, 10070, People’s Republic of China

    Zhan Xue, Xiudong Guan, Linhao Yuan, Peng Kang, Chuanbao Zhang, Deling Li, Guijun Jia & Wang Jia

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  1. Zhan Xue
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  2. Xiudong Guan
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  4. Peng Kang
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  8. Wang Jia
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Correspondence to Wang Jia.

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Ethical approval

The study was conducted in accordance with the Declaration of Helsinki and was approved by the Ethics Committee of Beijing Tiantan Hospital (No. QX2020-018–02). Written informed consent was obtained from each patient (or the legal guardian of pediatric patients) before study enrollment.

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The authors declare no competing interests.

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Xue, Z., Guan, X., Yuan, L. et al. Laser interstitial thermal therapy in the treatment of brain metastases: the relationship between changes in postoperative magnetic resonance imaging characteristics and tumor recurrence. Acta Neurochir 165, 1379–1387 (2023). https://doi.org/10.1007/s00701-023-05504-x

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