Butterfly gliomas: to biopsy or to ablate - a longitudinal cohort study

Area of Science:

• Neuro-oncology
• Minimally Invasive Neurosurgery
• Oncologic Outcomes

Background:

• Butterfly gliomas are aggressive high-grade gliomas with bilateral involvement.
• Standard treatment often involves biopsy and chemoradiation, limiting surgical resection options.
• Laser interstitial thermal therapy (LITT) presents a minimally invasive alternative for improved survival.

Purpose of the Study:

• To compare outcomes between biopsy alone and LITT for butterfly gliomas.
• To analyze demographic, perioperative, and survival metrics.
• To investigate procedural and volumetric factors influencing LITT efficacy.

Main Methods:

• Retrospective comparison of patients undergoing biopsy versus LITT.
• Analysis of demographic data, perioperative outcomes, and survival.
• Procedural and volumetric analyses including extent of ablation (EOA) and residual tumor burden (RTB) within the LITT cohort.

Main Results:

• LITT demonstrated significantly longer overall survival (14.86 vs. 4.93 months) and progression-free survival (4.67 vs. 2.53 months) compared to biopsy.
• Larger preoperative tumor volumes in LITT correlated with lower EOA and higher RTB.
• Postoperative KPS improvement was linked to improved overall survival (OS) and progression-free survival (PFS).

Conclusions:

• LITT is associated with improved survival for butterfly gliomas compared to biopsy alone, with no increase in perioperative morbidity.
• Volumetric thresholds alone may be insufficient for assessing treatment adequacy in LITT for complex tumors.
• LITT offers a viable, less invasive treatment option for this challenging glioma subtype.