Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut.
Department of Neurosurgery, Washington University School of Medicine, St Louis, Missouri.
Neurosurgery. 2018 Jan 1;82(1):56-63. doi: 10.1093/neuros/nyx142.
Radiosurgical failure following stereotactic radiosurgery for brain metastases can be attributed to tumor regrowth or radiation necrosis. MRI-guided laser thermal ablation (LTA) therapy has emerged as an option for treatment; however, previous literature demonstrates variable results across centers.
To assess the outcomes of LTA in the treatment of metastases failing radiosurgery across multiple centers and to determine if any treatment factors are predictive of outcome.
Clinical data for 30 patients across 4 centers were retrospectively reviewed. Patients were included if they received LTA therapy following radiosurgical failure due to radiation necrosis or tumor regrowth. Demographics, surgical data, and follow-up imaging and clinical information were collected. Linear regression analyses were performed to determine treatment factors that were associated with post-LTA outcome.
The large majority of patients responded favorably to LTA treatment with low complication rates (23%), short length of stay (53% ≤ 2 d) and reductions in perilesional edema (63%). A total of 73.3% of patients stopped steroids and 48% saw improvement of their preoperative symptoms. Patients with better pre-LTA Karnofsky Performance Status had better survival. Patients who had lesions with more perilesional T2 change post-LTA had a better chance of weaning off steroids and obtaining symptomatic relief.
MRI-guided laser thermal ablation therapy serves as a viable alternative to traditional treatment options for metastatic brain lesions failing radiosurgery. Although this study is limited by size and is retrospective, LTA therapy may result in symptomatic improvement and a more prominent reduction in fluid-attenuated inversion-recovery signal for larger lesions.
立体定向放射外科治疗脑转移瘤后发生放射外科失败可归因于肿瘤复发或放射性坏死。MRI 引导下激光热消融（LTA）治疗已成为一种治疗选择；然而，之前的文献表明不同中心的结果存在差异。
评估 LTA 在多个中心治疗放射外科治疗失败的转移瘤的疗效，并确定是否有任何治疗因素对疗效有预测作用。
回顾性分析了 4 个中心的 30 例患者的临床资料。如果患者因放射性坏死或肿瘤复发而在放射外科治疗失败后接受 LTA 治疗，则将其纳入研究。收集了患者的人口统计学、手术数据以及随访影像学和临床资料。进行线性回归分析，以确定与 LTA 后转归相关的治疗因素。
绝大多数患者对 LTA 治疗反应良好，并发症发生率低（23%），住院时间短（53%≤2 天），瘤周水肿减轻（63%）。共有 73.3%的患者停止使用类固醇，48%的患者术前症状得到改善。Karnofsky 表现状态较好的患者生存时间更长。LTA 后瘤周 T2 变化较大的患者更有可能停止使用类固醇并获得症状缓解。
MRI 引导下激光热消融治疗是治疗放射外科治疗失败的脑转移瘤的一种可行替代方法。尽管本研究受到大小和回顾性的限制，但 LTA 治疗可能会导致症状改善，并更显著地减少更大病变的液体衰减反转恢复信号。
