Laser Thermal Ablation for Metastases Failing Radiosurgery: A Multicentered Retrospective Study

Neurosurgery. 2018 Jan 1;82(1):56-63. doi: 10.1093/neuros/nyx142.

Abstract

Background: Radiosurgical failure following stereotactic radiosurgery for brain metastases can be attributed to tumor regrowth or radiation necrosis. MRI-guided laser thermal ablation (LTA) therapy has emerged as an option for treatment; however, previous literature demonstrates variable results across centers.

Objective: To assess the outcomes of LTA in the treatment of metastases failing radiosurgery across multiple centers and to determine if any treatment factors are predictive of outcome.

Methods: Clinical data for 30 patients across 4 centers were retrospectively reviewed. Patients were included if they received LTA therapy following radiosurgical failure due to radiation necrosis or tumor regrowth. Demographics, surgical data, and follow-up imaging and clinical information were collected. Linear regression analyses were performed to determine treatment factors that were associated with post-LTA outcome.

Results: The large majority of patients responded favorably to LTA treatment with low complication rates (23%), short length of stay (53% ≤ 2 d) and reductions in perilesional edema (63%). A total of 73.3% of patients stopped steroids and 48% saw improvement of their preoperative symptoms. Patients with better pre-LTA Karnofsky Performance Status had better survival. Patients who had lesions with more perilesional T2 change post-LTA had a better chance of weaning off steroids and obtaining symptomatic relief.

Conclusion: MRI-guided laser thermal ablation therapy serves as a viable alternative to traditional treatment options for metastatic brain lesions failing radiosurgery. Although this study is limited by size and is retrospective, LTA therapy may result in symptomatic improvement and a more prominent reduction in fluid-attenuated inversion-recovery signal for larger lesions.

Keywords: Brain metastases; ablation; multicentered study; outcome; radiation necrosis; radiosurgery; thermocoagulation.

Publication types

  • Multicenter Study

MeSH terms

  • Adult
  • Aged
  • Brain Neoplasms / mortality
  • Brain Neoplasms / secondary*
  • Brain Neoplasms / therapy*
  • Female
  • Follow-Up Studies
  • Humans
  • Laser Therapy / methods*
  • Magnetic Resonance Imaging / methods
  • Male
  • Middle Aged
  • Radiosurgery / methods*
  • Radiosurgery / mortality
  • Retrospective Studies
  • Salvage Therapy / methods*
  • Salvage Therapy / mortality
  • Survival Rate / trends
  • Treatment Failure