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Laser interstitial thermal therapy for in-field recurrence of brain metastasis after stereotactic radiosurgery: does treatment with LITT prevent a neurologic death?

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Abstract

Brain metastasis (BM) affects up to one-third of adults with cancer and carries a historically bleak prognosis. Despite advances in stereotactic radiosurgery (SRS), rates of in-field recurrence (IFR) after SRS range from 10 to 25%. High rates of neurologic death have been reported after SRS failure, particularly for recurrences deep in the brain and surgically inaccessible. Laser interstitial thermal therapy (LITT) is an emerging option in this setting, but its ability to prevent a neurologic death is unknown. In this study, we investigate the causes of death among patients with BM who undergo LITT for IFR after SRS. We conducted a single institution retrospective case series of patients with BM who underwent LITT for IFR after SRS. Clinical and demographic data were collected via chart review. The primary endpoint was cause of death. Between 2010 and 2018, 70 patients with BM underwent LITT for IFR after SRS. Median follow-up after LITT was 12.0 months. At analysis, 49 patients died; a cause was determined in 44. Death was neurologic in 20 patients and non-neurologic in 24. The 24-month cumulative incidence of neurologic and non-neurologic death was 35.1% and 38.6%, respectively. Etiologies of neurologic death included local recurrence (n = 7), recovery failure (n = 7), distant progression (n = 5), and other (n = 1). Among our patient population, LITT provided the ability to stabilize neurologic disease in up to 2/3 of patients. For IFR after SRS, LITT may represent a reasonable treatment strategy for select patients. Additional work is necessary to determine the extent to which LITT can prevent neurologic death after recurrence of BM.

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Data availability

The data that support the findings of this study are available from the corresponding author, [J.K.], upon reasonable request.

Abbreviations

BM:

Brain metastasis

SRS:

Stereotactic radiosurgery

IFR:

In-field recurrence

LITT:

Laser interstitial thermal therapy

KPS:

Karnofsky Performance Status

OS:

Overall survival

WBRT:

Whole brain radiation therapy

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Acknowledgements

We thank Patrick Hilden (Patrick.Hilden@rwjbh.org) for his expertise and contributions to the statistical methodology and analyses.

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Authors and Affiliations

  1. Department of Neurosurgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA

    Joel Kaye, Nitesh V. Patel & Shabbar F. Danish

Authors
  1. Joel Kaye
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  2. Nitesh V. Patel
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  3. Shabbar F. Danish
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Contributions

All authors contributed to the study conception and design. Data collection and analysis were performed by Joel Kaye, Shabbar Danish, and Nitesh Patel. The first draft of the manuscript was written by Joel Kaye and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Joel Kaye.

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Conflict of interest

Dr. Shabbar Danish is a consultant for Medtronic and receives honorarium. The other authors have no personal, financial, or institutional interest in any of the materials or devices described in this article.

Ethics approval

This retrospective chart review study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. All procedures performed were part of the routine care. This study was conducted with the approval of the Rutgers University Institutional Review Board.

Informed consent

Informed consent was obtained prior to treatment from all individual patients included in the study. All patients signed informed consent regarding publishing their data. The authors affirm that all information contained in our manuscript is non-identifying and anonymized.

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Kaye, J., Patel, N.V. & Danish, S.F. Laser interstitial thermal therapy for in-field recurrence of brain metastasis after stereotactic radiosurgery: does treatment with LITT prevent a neurologic death?. Clin Exp Metastasis 37, 435–444 (2020). https://doi.org/10.1007/s10585-020-10035-1

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  • DOI: https://doi.org/10.1007/s10585-020-10035-1

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