Patel Nitesh V, Jethwa Pinakin R, Shetty Anil, Danish Shabbar F
Division of Neurosurgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey;
J Neurosurg Pediatr. 2015 Apr;15(4):363-71. doi: 10.3171/2014.10.PEDS13698. Epub 2015 Jan 16.
OBJECT Although control of intracranial ependymomas is highly correlated with degree of resection, it is unknown if the same is true for MRI-guided laser-induced thermal therapy (MRgLITT). The authors report their experience with MRgLITT for ependymoma and examine the utility of the real-time thermal damage estimate (TDE), a recent software advance, with respect to completeness of ablation and impact on tumor control. To the authors' knowledge, this is the largest single-center experience utilizing MRgLITT for recurrent ependymomas. METHODS Five tumors in 4 patients were treated with the Visualase Thermal Therapy System. Two tumors were treated similarly on recurrence. Ablation was performed using a 980-nm diode laser with a real-time image acquisition system. Single-plane TDEs were calculated and compared with the original lesion area to compute percentage area ablated (PAA). Volumetric analysis was performed, and percentage volume ablated (PVA) was estimated and correlated with the TDE. Tumor control was correlated with the TDE and volumetric data during treatment. RESULTS Nine ablations were performed on 5 tumors, 2 of which had multiple recurrences. The average pretreatment lesion volume was 8.4 ± 6.3 cm(3), and the average largest 2D area was 5.3 ± 2.7 cm(2). The averaged TDE was 3.9 ± 2.1 cm(2), average PAA was 80.1% ± 34.3%, and average PVA was 64.4% ± 23.5%. For subtotal ablations, average recurrence time was 4.4 ± 5.3 months; 1 adult case remains recurrence-free at 40 months. Using TDEs, the correlation between recurrence time and PAA was r = 0.93 (p = 0.01), and for PVA was r = 0.88 (p = 0.02). Furthermore, PVA and PAA were strongly correlated (r = 0.88, p = 0.02). CONCLUSIONS Through using the PAA, the real-time TDE correlated with the volume of ablation in this initial investigation. Furthermore, the TDE and volumetric data corresponded to the level of tumor control, with time to recurrence dependent on ablation completeness. MRgLITT may have a role in the management of recurrent ependymomas, especially with recent software advances.
目的 虽然颅内室管膜瘤的控制与切除程度高度相关，但对于磁共振成像引导激光诱导热疗（MRgLITT）是否同样如此尚不清楚。作者报告了他们使用MRgLITT治疗室管膜瘤的经验，并研究了实时热损伤估计（TDE）（一种最新的软件进展）在消融完整性及对肿瘤控制影响方面的效用。据作者所知，这是利用MRgLITT治疗复发性室管膜瘤的最大单中心经验。方法 4例患者的5个肿瘤采用Visualase热疗系统治疗。2个肿瘤复发时接受了类似治疗。使用980纳米二极管激光和实时图像采集系统进行消融。计算单平面TDE，并与原始病变面积比较以计算消融面积百分比（PAA）。进行体积分析，估计消融体积百分比（PVA）并与TDE相关联。治疗期间将肿瘤控制与TDE和体积数据相关联。结果 对5个肿瘤进行了9次消融，其中2个有多次复发。术前平均病变体积为8.4±6.3立方厘米，平均最大二维面积为5.3±2.7平方厘米。平均TDE为3.9±2.1平方厘米，平均PAA为80.1%±34.3%，平均PVA为64.4%±23.5%。对于次全消融，平均复发时间为4.4±5.3个月；1例成年病例在40个月时仍无复发。使用TDE，复发时间与PAA的相关性为r = 0.93（p = 0.01），与PVA的相关性为r = 0.88（p = 0.02）。此外，PVA和PAA高度相关（r = 0.88，p = 0.02）。结论 在这项初步研究中，通过使用PAA，实时TDE与消融体积相关。此外，TDE和体积数据与肿瘤控制水平相对应，复发时间取决于消融的完整性。MRgLITT可能在复发性室管膜瘤的治疗中发挥作用，尤其是随着近期软件的进展。
