Department of Neurosurgery, Yale University School of Medicine, PO Box 208082, New Haven, CT 06520-8082, USA.
J Neurooncol. 2013 Jul;113(3):495-503. doi: 10.1007/s11060-013-1142-2. Epub 2013 May 16.
Since the inception of radiosurgery, the management of brain metastases has become a common problem for neurosurgeons. Although the use of stereotactic radiosurgery and/or whole brain radiation therapy serves to control the majority of disease burden, patients who survive longer than 6-8 months sometimes face the problem of symptomatic radiographically regrowing lesions with few treatment options. Here we investigate the feasibility of use of MRI-guided stereotactic laser induced thermotherapy (LITT) as a novel treatment option for these lesions. Six patients who had previously undergone gamma knife stereotactic radiosurgery for brain metastases were selected. All patients had an initial favorable response to radiosurgery but subsequently developed regrowth of at least one lesion associated with recurrent edema and progressive neurological symptoms requiring ongoing steroids for symptom control. All lesions were evaluated for craniotomy, but were deemed unresectable due to deep location or patient's comorbidities. Stereotactic biopsies were performed prior to the thermotherapy procedure in all cases. LITT was performed using the Visualase system and follow-up MRI imaging was used to determine treatment response. In all six patients biopsy results were negative for tumor and consistent with adverse radiation effects also known as radiation necrosis. Patients tolerated the procedure well and were discharged from the hospital within 48 h of the procedure. In 4/6 cases there was durable improvement of neurological symptoms until death. In all cases steroids were weaned off within 2 months. One patient died from systemic causes related to his cancer a month after the procedure. One patient had regrowth of the lesion 3 months after the procedure and required re-initiation of steroids and standard craniotomy for surgical resection. There were no complications directly related to the thermocoagulation procedure. Stereotactic laser induced thermotherapy is a feasible alternative for the treatment of symptomatic regrowing metastatic lesions after radiosurgery. The procedure carries minimal morbidity and, in this small series, shows some effectiveness in the symptomatic relief of edema and neurological symptoms paralleled by radiographic lesional control. Further studies are necessary to elucidate the safety of this technology.
自放射外科出现以来，脑转移的管理已成为神经外科医生的常见问题。尽管使用立体定向放射外科和/或全脑放射治疗可以控制大多数疾病负担，但存活时间超过 6-8 个月的患者有时会面临症状性影像学复发性病变的问题，且治疗选择有限。在这里，我们研究了 MRI 引导下立体定向激光诱导热疗（LITT）作为这些病变的新治疗选择的可行性。选择了 6 名先前因脑转移接受伽玛刀立体定向放射外科治疗的患者。所有患者对放射外科均有初始良好反应，但随后至少有一种病变复发，伴有复发性水肿和进行性神经症状，需要持续使用类固醇控制症状。所有病变均评估了开颅手术，但由于病变位置深或患者合并症而认为无法切除。所有病例均在热疗前进行了立体定向活检。LITT 使用 Visualase 系统进行，随访 MRI 成像用于确定治疗反应。在所有 6 例患者中，活检结果均为肿瘤阴性，与已知的放射性坏死也即放射性损伤一致。患者对该程序耐受良好，在程序后 48 小时内出院。在 4/6 例中，神经症状有持久改善，直至死亡。在所有病例中，类固醇在 2 个月内逐渐减少。1 例患者在手术后 1 个月因与癌症相关的全身原因死亡。1 例患者在手术后 3 个月时病变复发，需要重新开始使用类固醇和标准开颅手术进行切除。没有与热凝程序直接相关的并发症。立体定向激光诱导热疗是放射外科后治疗症状性复发性转移性病变的可行替代方法。该程序的发病率低，在这个小系列中，在水肿和神经症状的症状缓解方面显示出一定的效果，同时影像学上病变得到控制。需要进一步的研究来阐明该技术的安全性。
