The use of laser interstitial thermal therapy in the treatment of brain metastases: a literature review

Figures & data

Figure 1. Display interface of the NeuroBlade System during ablation of deep-seated occipital brain metastases. Using this interface it is possible to assess the extent of ablation in three axial levels perpendicular to the laser probe (upper panels). On the bottom panels, it is possible to observe the sagittal and coronal planes, parallel to the probe. Note use of DTI-tractography (in white) to generate the optic radiations.

Table 1. Large published cohorts on the use of LITT treat brain metastases.

Study and year	Type lesion treated	Biospsy	# Patients/ # Lesions	Complications	PFS/Local control rate	OS/Survival rate
Ali et al. [34]	NR	NR	23/26	21%	NR/35% with incomplete ablated lesions	NR
Patel el al. [33]	NR	NR	37/37	29%	NR/NR	NR
Beechar et al. [35]	NR	NR	36/50	44%	9.8 months/NR	Median not reached
Kamath et al. [36]	Recurrent tumor	Yes	25/25	15%	Median not reached/NR	NR/17.2%
Ahluwalia et al. [37]	Recurrent tumor and RN	Yes	42/42	11.9%	NR/26% in 12 weeks	NR/ 72.2% in 26 weeks
Chaunzwa et al. [38]	Recurrent tumor and RN	Yes	30/30	20%	NR/83%	NR
Hernandez et al. [39]	NR	NR	45/59	25%	NR/83.1%	NR
Salehi et al. [40]	NR	NR	24/25	20%	6.3 months/60%	13.27 months/NR
Bastos et al. [8]	Recurrent tumor and RN	No	61/82	26.2%	Median not reached/59.4%	29 months/NR
Hong et al. [41]	Recurrent tumor and RN	Yes	34/34	35.3%	NR/87.8% for RN and 54.7% for recurrent tumor	NR/73.8% for RN and 62.5% for recurrent tumor
Shah et al. [42]	Recurrent tumor and RN	Yes	56/65	4%	55.9 months/77.4% for recurrent tumor and 25% for RN	16.9 months/61%

NR: not reported; PFS: progression free survival; RN: radiation necrosis.

Figure 2. Images of 67-year-old male patient with a brain metastases recurrence after SRS from non-small cell lung cancer. (A) Pre-ablation axial T1C + MRI showing a deep seated ring enhancement in the left parietal lobe, compatible with recurrent tumor; (B) Pre-ablation Dynamic Contrast-Enhanced k-trans MR showing a high signal intensity inside the lesion suggesting high vascularization; (C) Post-ablation axial T1C + MRI showing the classic eggshell enhancement in the borders of the ablation; (D) Post-ablation MRI subtraction compatible with complete ablation; (E) Post-ablation axial Dynamic Contrast-Enhanced k-trans MR showing low signal intensity compatible with no viable tissue within the ablation zone; (F) One month post-ablation axial T1C + MRI showing eggshell enhancement and no signs of local recurrence; (G) Three month post-ablation axial T1C + MRI without local recurrence; (H) Six month post-ablation axial T1C + MRI with only remnant signs of ablation.

Figure 3. Images of 66-year-old female patient with metastatic breast cancer to the brain with a tumor recurrence after treatment with SRS. (A) Pre-ablation axial T1C + MRI showing a heterogeneous ring-enhancing lesion in the left frontoparietal region, compatible with recurrent tumor, note the large caliber vessel in the anterior third of the lesion (red arrow); (B) Pre-ablation sagittal T1C + MRI showing the large caliber vessel crossing the lesion; (C) ) Pre-ablation Dynamic Contrast-Enhanced k-trans MR showing a high signal intensity in the lesion’s margins compatible high vascularization; (D) Post-ablation axial T1C + MRI showing the classic eggshell enhancement in the margins of the ablation, notice in the anterior margin a solid enhancement compatible with unablated tissue (yellow arrow), it is possible that the large vessel worked as a heat sink preventing the complete ablation of the lesion; (E) Post-ablation MRI subtraction showing increased enhancement in the anterior margin of the ablation zone (yellow arrow); (F) Post-ablation axial Dynamic Contrast-Enhanced k-trans MR showing increased signal in the anterior margin of the ablation zone (yellow arrow); (G) One month post-ablation axial T1C + MRI showing eggshell enhancement a remnant unablated tumor in the anterior margin of the ablation zone; Three months post-ablation axial T1C + MRI showing tumor recurrence in the anterior part of the ablation zone.

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