Laser Interstitial Thermal Therapy for Brain Metastases: Imaging Guidelines for Clinical Trials and Practice

Area of Science:

• Neurosurgery
• Oncology
• Radiology

Background:

• Laser interstitial thermal therapy (LITT) is a key local treatment for brain metastases (BM).
• Radiologic assessment is crucial for patient selection, treatment planning, and monitoring LITT efficacy.
• Standardized imaging criteria are needed for evaluating treatment response and progression.

Purpose of the Study:

• To outline the radiologic findings and challenges associated with LITT for brain metastases.
• To propose standardized imaging criteria for assessing local response and progression after LITT.
• To offer recommendations for post-LITT surveillance imaging protocols.

Main Methods:

• Review of radiologic findings before, during, and after LITT for brain metastases.
• Analysis of intra-procedural imaging, including MR thermometry, for ablation monitoring.
• Adaptation of RANO-BM criteria into a dual baseline framework for LITT-treated BM.

Main Results:

• Pre-LITT imaging aids prognostic stratification and treatment planning.
• Intra-procedural imaging guides tumor delineation and monitors ablation extent.
• Post-LITT follow-up scans show distinct patterns for lesion response versus progression.

Conclusions:

• Standardized imaging protocols and dedicated response criteria are essential for LITT surveillance.
• The proposed dual baseline framework enhances the evaluation of LITT-treated brain metastases.
• Consistent radiologic assessment improves clinical trial interpretation and patient management.