Laser interstitial thermal therapy in the management of brain metastasis and radiation necrosis after radiosurgery: An overview

ABSTRACT

With advances in stereotactic and neuroimaging techniques, various minimally invasive image-guided techniques have gained widespread acceptance in the field of neuro-oncology. Laser interstitial thermal therapy (LITT) is an image-guided technique that involves generation of high temperatures using a laser fiber, to ablate pathological tissue. Radiation necrosis (RN) and radiosurgery resistant brain metastasis often pose significant challenges to the treating physicians. In the last two decades, various studies have documented the efficacy of LITT in managing radiosurgery resistant metastases, radiation necrosis, surgically inaccessible malignant gliomas and ablation of epileptogenic foci. The aim of this paper is to summarize the current literature on the efficacy of LITT in patients with radiation necrosis and brain metastasis. We have also touched upon the physical properties of currently available LITT systems and the mechanism of action of laser therapy including histopathological changes.

KEY WORDS:

• laser therapy
• thermal therapy
• radiation necrosis
• brain metastasis

Financial and competing interests disclosure

AM Mohammadi and GH Barnett are consultants for Monteris medical company. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Key issues

• Radiation necrosis (RN) and radiosurgery-resistant brain metastasis are clinical conundrum that pose significant challenges to the physicians.

• Laser interstitial thermal therapy (LITT) involves stereotactic placement of laser fiber with generation and precise control of high temperatures using MR thermometry (thermal damage threshold lines) to ablate the pathological tissues.

• Earlier studies have shown significant benefits of LITT in patients with RN and metastasis in terms of both progression-free and overall survival.

• Laser-induced thermal therapy is a minimally invasive technique that can offer hope to patients with significant medical comorbidities and such deep-seated tumors.

• Long-term randomized prospective controlled studies are warranted to provide high level of evidence regarding the efficacy of LITT in patients with RN and metastatic brain tumors.