The role of laser interstitial thermal therapy in enhancing progression-free survival of difficult-to-access high-grade gliomas: a multicenter study

Alireza M Mohammadi, Ammar H Hawasli, Analiz Rodriguez, Jason L Schroeder, Adrian W Laxton, Paul Elson, Stephen B Tatter, Gene H Barnett, Eric C Leuthardt, Alireza M Mohammadi, Ammar H Hawasli, Analiz Rodriguez, Jason L Schroeder, Adrian W Laxton, Paul Elson, Stephen B Tatter, Gene H Barnett, Eric C Leuthardt

Abstract

Surgical extent-of-resection has been shown to have an impact on high-grade glioma (HGG) outcomes; however, complete resection is rarely achievable in difficult-to-access (DTA) tumors. Controlled thermal damage to the tumor may have the same impact in DTA-HGGs. We report our multicenter results of laser interstitial thermal therapy (LITT) in DTA-HGGs. We retrospectively reviewed 34 consecutive DTA-HGG patients (24 glioblastoma, 10 anaplastic) who underwent LITT at Cleveland Clinic, Washington University, and Wake Forest University (May 2011-December 2012) using the NeuroBlate(®) System. The extent of thermal damage was determined using thermal damage threshold (TDT) lines: yellow TDT line (43 °C for 2 min) and blue TDT line (43°C for 10 min). Volumetric analysis was performed to determine the extent-of-coverage of tumor volume by TDT lines. Patient outcomes were evaluated statistically. LITT was delivered as upfront in 19 and delivered as salvage in 16 cases. After 7.2 months of follow-up, 71% of cases demonstrated progression and 34% died. The median overall survival (OS) for the cohort was not reached; however, the 1-year estimate of OS was 68 ± 9%. Median progression-free survival (PFS) was 5.1 months. Thirteen cases who met the following two criteria-(1) <0.05 cm(3) tumor volume not covered by the yellow TDT line and (2) <1.5 cm(3) additional tumor volume not covered by the blue TDT line-had better PFS than the other 21 cases (9.7 vs. 4.6 months; P = 0.02). LITT can be used effectively for treatment of DTA-HGGs. More complete coverage of tumor by TDT lines improves PFS which can be translated as the extent of resection concept for surgery.

Keywords: Anaplastic glioma; GBM; LITT; NeuroBlate System; laser ablation.

© 2014 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.

Figures

Figure 1
Figure 1
Schematic picture of NeuroBlate System for treatment of difficult to access brain tumors.
Figure 2
Figure 2
Blue and yellow TDT lines as well as tumor outline (pink) were imported to iPlan software for volumetric analysis.
Figure 3
Figure 3
Effect of TDT-line prognostic group on progression-free survival.
Figure 4
Figure 4
Correlation between tumor volume and the proportion of tumor covered by the “blue” line (for illustration purposes only the “blue” line is considered, but the same holds for the “yellow” line also).
Figure 5
Figure 5
NeuroBlate prognostic groups and tumor volume.

References

    1. Sanai N. Berger MS. Recent surgical management of gliomas. Adv. Exp. Med. Biol. 2012;746:12–25.
    1. Woodward D, Cook J, Tracqui P, Gruywagen G, Murray J. Alvord E. A mathematical moder of glioma growth. Cell Prolif. 1996;29:269–288.
    1. Fine HA, Dear KB, Loeffler JS, Black PM. Canellos GP. Meta-analysis of radiation therapy with and without adjuvant chemotherapy for malignant gliomas in adults. Cancer. 1993;71:2585–2597.
    1. Andersen AP. Postoperative irradiation of glioblastomas. Results in a randomized series. Acta Radiol. Oncol. Radiat. Phys. Biol. 1978;17:475–484.
    1. Walker MD, Alexander E, Jr, Hunt WE, MacCarty CS, Mahaley MS, Jr, Mealey J, Jr, et al. Evaluation of BCNU and/or radiotherapy in the treatment of anaplastic gliomas. A cooperative clinical trial. J. Neurosurg. 1978;49:333–343.
    1. Lacroix M, Abi-Said D, Fourney DR, Gokaslan ZL, Shi W, DeMonte F, et al. A multivariate analysis of 416 patients with glioblastoma multiforme: prognosis, extent of resection, and survival. J. Neurosurg. 2001;95:190–198.
    1. McGirt MJ, Chaichana KL, Gathinji M, Attenello FJ, Than K, Olivi A, et al. Independent association of extent of resection with survival in patients with malignant brain astrocytoma. J. Neurosurg. 2009;110:156–162.
    1. Sanai N, Polley M-Y, McDermott MW, Parsa AT. Berger MS. An extent of resection threshold for newly diagnosed glioblastomas. J. Neurosurg. 2011;115:3–8.
    1. Keles GE, Chang EF, Lamborn KR, Tihan T, Chang CJ, Chang SM, et al. Volumetric extent of resection and residual contrast enhancement on initial surgery as predictors of outcome in adult patients with hemispheric anaplastic astrocytoma. J. Neurosurg. 2006;105:34–40.
    1. Stummer W, Reulen HJ, Meinel T, Pichlmeier U, Schumacher W, Tonn JC, et al. Extent of resection and survival in glioblastoma multiforme: identification of and adjustment for bias. Neurosurgery. 2008;62:564–576. discussion 564–576.
    1. Rubin P, Fischbach J. Isaacson S. Influence of location and extent of surgical resection on survival of patients with glioblastoma multiforme: results of three consecutive Radiation Therapy Oncology Group (RTOG) clinical trials. Int. J. Radiat. Oncol. Biol. Phys. 1993;26:239–244.
    1. Vuorinen V, Hinkka S, Farkkila M. Jaaskelainen J. Debulking or biopsy of malignant glioma in elderly people – a randomised study. Acta Neurochir. (Wien) 2003;145:5–10.
    1. Sloan AE, Ahluwalia MS, Valerio-Pascua J, Manjila S, Torchia MG, Jones SE, et al. Results of the NeuroBlate System first-in-humans Phase I clinical trial for recurrent glioblastoma. J. Neurosurg. 2013;118:1202–1219.
    1. Schwarzmaier HJ, Eickmeyer F, von Tempelhoff W, Fiedler VU, Niehoff H, Ulrich SD, et al. MR-guided laser-induced interstitial thermotherapy of recurrent glioblastoma multiforme: preliminary results in 16 patients. Eur. J. Radiol. 2006;59:208–215.
    1. Brem H, Piantadosi S, Burger PC, Walker M, Selker R, Vick NA, et al. Placebo-controlled trial of safety and efficacy of intraoperative controlled delivery by biodegradable polymers of chemotherapy for recurrent gliomas. The Polymer-brain Tumor Treatment Group. Lancet. 1995;345:1008–1012.
    1. Bown SG. Phototherapy in tumors. World J. Surg. 1983;7:700–709.
    1. Sugiyama K, Sakai T, Fujishima I, Ryu H, Uemura K. Yokoyama T. Stereotactic interstitial laser-hyperthermia using Nd-YAG laser. Stereotact. Funct. Neurosurg. 1990;54–55:501–505.
    1. Schober R, Bettag M, Sabel M, Ulrich F. Hessel S. Fine structure of zonal changes in experimental Nd:YAG laser-induced interstitial hyperthermia. Lasers Surg. Med. 1993;13:234–241.
    1. Kahn T, Bettag M, Ulrich F, Schwarzmaier HJ, Schober R, Fürst G, et al. MRI-guided laser-induced interstitial thermotherapy of cerebral neoplasms. J. Comput. Assist. Tomogr. 1994;18:519–532.
    1. Ascher PW, Justich E. Schrottner O. A new surgical but less invasive treatment of central brain tumours Preliminary report. Acta Neurochir. Suppl. (Wien) 1991;52:78–80.
    1. Kahn T, Harth T, Bettag M, Schwabe B, Ulrich F, Schwarzmaier HJ, et al. Preliminary experience with the application of gadolinium-DTPA before MR imaging-guided laser-induced interstitial thermotherapy of brain tumors. J. Magn. Reson. Imaging. 1997;7:226–229.
    1. Kahn T, Harth T, Kiwit JC, Schwarzmaier HJ, Wald C. Modder U. In vivo MRI thermometry using a phase-sensitive sequence: preliminary experience during MRI-guided laser-induced interstitial thermotherapy of brain tumors. J. Magn. Reson. Imaging. 1998;8:160–164.
    1. Schwabe B, Kahn T, Harth T, Ulrich F. Schwarzmaier HJ. Laser-induced thermal lesions in the human brain: short- and long-term appearance on MRI. J. Comput. Assist. Tomogr. 1997;21:818–825.
    1. Schwarzmaier HJ, Yaroslavsky IV, Yaroslavsky AN, Fiedler V, Ulrich F. Kahn T. Treatment planning for MRI-guided laser-induced interstitial thermotherapy of brain tumors–the role of blood perfusion. J. Magn. Reson. Imaging. 1998;8:121–127.
    1. Bettag M, Ulrich F, Schober R, Fürst G, Langen KJ, Sabel M, et al. Stereotactic laser therapy in cerebral gliomas. Acta Neurochir. Suppl. (Wien) 1991;52:81–83.
    1. McNichols RJ, Kangasniemi M, Gowda A, Bankson JA, Price RE. Hazle JD. Technical developments for cerebral thermal treatment: water-cooled diffusing laser fibre tips and temperature-sensitive MRI using intersecting image planes. Int. J. Hyperthermia. 2004;20:45–56.
    1. De Poorter J, De Wagter C, De Deene Y, Thomsen C, Stahlberg F. Achten E. Noninvasive MRI thermometry with the proton resonance frequency (PRF) method: in vivo results in human muscle. Magn. Reson. Med. 1995;33:74–81.
    1. Carpentier A, McNichols RJ, Stafford RJ, Guichard JP, Reizine D, Delaloge S, et al. Laser thermal therapy: real-time MRI-guided and computer-controlled procedures for metastatic brain tumors. Lasers Surg. Med. 2011;43:943–950.
    1. Schwarzmaier HJ, Eickmeyer F, von Tempelhoff W, Fiedler VU, Niehoff H, Ulrich SD, et al. MR-guided laser irradiation of recurrent glioblastomas. J. Magn. Reson. Imaging. 2005;22:799–803.
    1. Reimer P, Bremer C, Horch C, Morgenroth C, Allkemper T. Schuierer G. MR-monitored LITT as a palliative concept in patients with high grade gliomas: preliminary clinical experience. J. Magn. Reson. Imaging. 1998;8:240–244.
    1. Sanai N. Berger MS. Glioma extent of resection and its impact on patient outcome. Neurosurgery. 2008;62:753–766.
    1. Jeremic B, Grujicic D, Antunovic V, Djuric L, Stojanovic M. Shibamoto Y. Influence of extent of surgery and tumor location on treatment outcome of patients with glioblastoma multiforme treated with combined modality approach. J. Neurooncol. 1994;21:177–185.
    1. Keles GE, Anderson B. Berger MS. The effect of extent of resection on time to tumor progression and survival in patients with glioblastoma multiforme of the cerebral hemisphere. Surg. Neurol. 1999;52:371–379.
    1. Ushio Y, Kochi M, Hamada J, Kai Y. Nakamura H. Effect of surgical removal on survival and quality of life in patients with supratentorial glioblastoma. Neurol. Med. Chir. (Tokyo) 2005;45:454–460. discussion 460–451.

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