Magnetic resonance imaging-guided laser interstitial thermal therapy (LITT) appears to be safe and effective for glioblastomas in select patients and may add an average of 2 months to life expectancy compared with the current standard of care, according to a new report published in the journal Neurosurgery.
“We showed that the procedure is well tolerated and that recurrent patients had a meaningful clinical benefit that seems to be better when compared with previously published data on the current standard of care,” said Eric Leuthardt, MD, senior study author and a professor of neurosurgery, neuroscience, biomedical engineering, and mechanical engineering & applied science at Washington University School of Medicine in St. Louis, Missouri.
Even when initial treatment with surgery, radiation, and chemotherapy is successful for glioblastomas, these tumors typically recur, leaving patients with few options. Dr. Leuthardt said these nefarious tumors are usually not curable but significant advances are occurring.
Leuthardt and colleagues examined survival data for all laser treatments for glioblastoma from 2010 to 2016 at a single institution. During that time, 54 patients received 58 laser treatments. Of those, 17 treatments were performed on inoperable tumors and 41 on tumors that recurred after primary treatment. In this series of patients, 40 tumors were lobar in location and 18 were in deep structures (the thalamus, insula, or corpus callosum). The average tumor volume was 12.5 ± 13.4 cm3, according to the authors.
During the study, 7 perioperative complications and 2 mortalities occurred. The median overall survival (OS) after LITT for the total cohort was 11.5 months. Median progression-free survival (PFS) was 6.6 months. Other studies have found that PFS is about 9 months for patients with these types of glioblastoma who are treated with the chemotherapy drugs bevacizumab or temozolomide.
“Overall risks were reasonable. There was a 12% risk of swelling or seizures and a low mortality rate of 3.4%,” Dr. Leuthardt told Cancer Network. “At this juncture, LITT should be considered a reasonable option for patients with focal nodular recurrent glioblastoma. Patients treated with LITT are doing better than typical treatments with bevacizumab. Next steps will require more formalized comparison in a randomized controlled trial to establish the standard of care.”
Yi Fan, MD, PhD, Assistant Professor in the Department of Radiation Oncology at the Smilow Center for Translational Research at the University of Pennsylvania Perelman School of Medicine in Philadelphia, Pennsylvania, said this approach is attractive because it is less invasive and patients usually go home within 24 to 48 hours. “Laser therapy is ideally suited, but not limited to, patients with deep-seeded tumors, which are difficult for surgical resection. Dr. Leuthardt is a pioneer in laser therapy of tumors. This recently published work by his team shows that local laser treatment extends patients’ survival by about 2 months, representing an exciting advance in the field,” Dr. Fan told Cancer Network.
- Kamath AA, Friedman DD, Akbari SH, et al. Glioblastoma Treated with MRI-Guided Laser Interstitial Thermal Therapy: Safety, Efficacy, and Outcomes. Neurosurgery. 2018 Aug 22. [Epub ahead of print]