Laser ablation after stereotactic radiosurgery: a multicenter prospective study in patients with metastatic brain tumors and radiation necrosis

• Published in: Journal of neurosurgery Vol. 130; no. 3; p. 804
• Main Authors: Ahluwalia, Manmeet, Barnett, Gene H, Deng, Di, Tatter, Stephen B, Laxton, Adrian W, Mohammadi, Alireza M, Leuthardt, Eric, Chamoun, Roukoz, Judy, Kevin, Asher, Anthony, Essig, Marco, Dietrich, Jorg, Chiang, Veronica L
• Format: Journal Article
• Language: English
• Published: United States 01.03.2019
• Subjects: Ablation Techniques; Adult; Aged; Brain Neoplasms - secondary; Brain Neoplasms - surgery; Female; Humans; Karnofsky Performance Status; Laser Therapy - methods; Magnetic Resonance Imaging; Male; Middle Aged; Necrosis; Neoplasm Recurrence, Local; Postoperative Complications - diagnostic imaging; Postoperative Complications - psychology; Postoperative Complications - surgery; Progression-Free Survival; Prospective Studies; Quality of Life; Radiation Injuries - diagnostic imaging; Radiation Injuries - psychology; Radiation Injuries - surgery; Radiosurgery - adverse effects; Radiosurgery - methods; Treatment Outcome; RANO-BM = Response Assessment in Neuro-Oncology Brain Metastases; CNS = central nervous system; NeuroBlate; LAASR = Laser Ablation After Stereotactic Radiosurgery; PFS = progression-free survival; LAASR; MMSE = Mini-Mental State Examination; PD = progressive disease; radiation necrosis; PR = partial response; SRS = stereotactic radiosurgery; RN = radiation necrosis; FACT-Br = Functional Assessment of Cancer Therapy-Brain; oncology; OS = overall survival; laser interstitial thermal therapy; LITT = laser interstitial thermal therapy; Laser Ablation After Stereotactic Radiosurgery; KPS = Karnofksy Performance Scale; QOL = quality of life; CR = complete response; HVLT-R = Hopkins Verbal Learning Test–Revised; metastatic brain tumor
• ISSN: 1933-0693
• DOI: 10.3171/2017.11.JNS171273

Laser Ablation After Stereotactic Radiosurgery (LAASR) is a multicenter prospective study of laser interstitial thermal (LITT) ablation in patients with radiographic progression after stereotactic radiosurgery for brain metastases. Patients with a Karnofsky Performance Scale (KPS) score ≥ 60, an age > 18 years, and surgical eligibility were included in this study. The primary outcome was local progression-free survival (PFS) assessed using the Response Assessment in Neuro-Oncology Brain Metastases (RANO-BM) criteria. Secondary outcomes were overall survival (OS), procedure safety, neurocognitive function, and quality of life. Forty-two patients—19 with biopsy-proven radiation necrosis, 20 with recurrent tumor, and 3 with no diagnosis—were enrolled. The median age was 60 years, 64% of the subjects were female, and the median baseline KPS score was 85. Mean lesion volume was 6.4 cm3 (range 0.4–38.6 cm3). There was no significant difference in length of stay between the recurrent tumor and radiation necrosis patients (median 2.3 vs 1.7 days, respectively). Progression-free survival and OS rates were 74% (20/27) and 72%, respectively, at 26 weeks. Thirty percent of subjects were able to stop or reduce steroid usage by 12 weeks after surgery. Median KPS score, quality of life, and neurocognitive results did not change significantly for either group over the duration of survival. Adverse events were also similar for the two groups, with no significant difference in the overall event rate. There was a 12-week PFS and OS advantage for the radiation necrosis patients compared with the recurrent tumor or tumor progression patients. In this study, in which enrolled patients had few alternative options for salvage treatment, LITT ablation stabilized the KPS score, preserved quality of life and cognition, had a steroid-sparing effect, and was performed safely in the majority of cases.