Department of Neurological Surgery, Rutgers University, New Brunswick, New Jersey.
Neurosurgery. 2019 Jul 1;85(1):84-90. doi: 10.1093/neuros/nyy220.
In patients who have previously undergone maximum radiation for metastatic brain tumors, a progressive enhancing inflammatory reaction (PEIR) that represents either tumor recurrence or radiation necrosis, or a combination of both, can occur. Magnetic resonance-guided laser-induced thermal therapy (LITT) offers a minimally invasive treatment option for this problem.
To report our single-center experience using LITT to treat PEIRs after radiosurgery for brain metastases.
Patients with progressive, enhancing reactions at the site of prior radiosurgery for metastatic brain tumors and who had a Karnofsky performance status of ≥70 were eligible for LITT. The primary endpoint was local control. Secondary end points included dexamethasone use and procedure-related complications.
Between 2010 and 2017, 59 patients who underwent 74 LITT procedures for 74 PEIRs met inclusion criteria. The mean pre-LITT PEIR size measured 3.4 ± 0.4 cm3. At a median follow-up of 44.6 wk post-LITT, the local control rate was 83.1%. Most patients were weaned off steroids post-LITT. Patients experiencing a post-LITT complication were more likely to remain on steroids indefinitely. The rate of new permanent neurological deficit was 3.4%.
LITT is an effective treatment for local control of PEIRs after radiosurgery for metastatic brain disease. When possible, we recommend offering LITT once PEIRs are identified and prior to the initiation of high-dose steroids for symptom relief.
对于先前接受过转移性脑肿瘤最大放射治疗的患者，可能会出现代表肿瘤复发或放射性坏死或两者兼有的进行性增强炎症反应（PEIR）。磁共振引导激光诱导热疗（LITT）为这一问题提供了一种微创治疗选择。
报告我们使用 LITT 治疗脑转移瘤放射外科治疗后 PEIR 的单中心经验。
符合条件的患者为先前接受过转移性脑肿瘤放射外科治疗后出现进行性增强反应且 Karnofsky 表现状态≥70的患者。主要终点是局部控制。次要终点包括地塞米松的使用和与手术相关的并发症。
在 2010 年至 2017 年间，59 名患者接受了 74 次 LITT 治疗 74 个 PEIR，符合纳入标准。LITT 前 PEIR 的平均大小为 3.4±0.4cm3。在 LITT 后中位随访 44.6 周时，局部控制率为 83.1%。大多数患者在 LITT 后逐渐停用激素。发生 LITT 后并发症的患者更有可能无限期地继续使用激素。新发永久性神经功能缺损的发生率为 3.4%。
LITT 是治疗放射性治疗转移性脑疾病后 PEIR 的有效方法。一旦发现 PEIR 并在开始使用大剂量类固醇缓解症状之前，我们建议尽可能提供 LITT。
