MR-guided laser-induced thermal therapy (LITT) for recurrent glioblastomas

Laser-induced thermal therapy (LITT), coupled with magnetic resonance thermal imaging (MRTI) guidance, provides a minimally invasive and safe approach to treat brain tumors, especially metastases. We report here our experience using this treatment for recurrent glioblastomas.

Four patients, from 40 to 58 years old, were diagnosed with glioblastoma. After total resection, chemotherapy and radiation therapy, recurrence occurred. As each was ineligible for a second surgery, LITT was proposed as salvage therapy. Under stereotactic guidance, a fiberoptic applicator was inserted within the tumor LITT was performed under continuous MRTI. Real-time feedback control based on MRTI was employed to assess the quality of local tissue destruction and to prevent unwanted damage to nearby structures.

The procedure was well tolerated with no peroperative neurological deterioration. In the short-term follow-up, one transient supplementary motor area syndrome, one epileptic seizure, and one cerebrospinal fluid leakage occurred. All were successfully managed. Post-procedure MRI showed no complication, satisfying treatment volume, and a decrease in size of the treated tumor. For all patients, recurrence was observed with a mean/median progression free survival of 37/30 days. Mean/median overall survival after LITT was 10.5/10 months.

Focal tumor control was performed safely using minimally invasive LITT with real-time MRTI control. LITT could be considered as salvage therapy for high-grade recurrent gliomas if a 1-day treatment is considered useful for a few weeks gain in survival. Larger experience will be required to define indications for such infiltrative disease and accurately determine a potentially significant survival gain in good neurological condition associated with this 1-day procedure.