Laser thermal ablation for metastases failing radiosurgery: A multicentered retrospective study

Tafadzwa L. Chaunzwa, Di Deng, Eric C. Leuthardt, Stephen B. Tatter, Alireda M. Mohammadi, Gene H. Barnett, Veronica L. Chiang

Research output: Contribution to journalArticle

20 Scopus citations

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.

Original languageEnglish
Pages (from-to)56-63
Number of pages8
JournalNeurosurgery
Volume82
Issue number1
DOIs
StatePublished - Jan 1 2018

Keywords

  • Ablation
  • Brain metastases
  • Multicentered study
  • Outcome
  • Radiation necrosis
  • Radiosurgery
  • Thermocoagulation

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    Chaunzwa, T. L., Deng, D., Leuthardt, E. C., Tatter, S. B., Mohammadi, A. M., Barnett, G. H., & Chiang, V. L. (2018). Laser thermal ablation for metastases failing radiosurgery: A multicentered retrospective study. Neurosurgery, 82(1), 56-63. https://doi.org/10.1093/neuros/nyx142