Department of Neurosurgery, Yale University School of Medicine, 333 Cedar Street, New Haven, CT, 06520, USA.
J Neurooncol. 2019 Apr;142(2):309-317. doi: 10.1007/s11060-019-03097-z. Epub 2019 Jan 17.
Many publications report laser-interstitial thermal therapy (LITT) as a viable alternative treatment to craniotomy for radiation necrosis (RN) and re-growing tumor occurring after stereotactic radiosurgery (SRS) for brain metastases. No studies to-date have compared the two options. The aim of this study was to retrospectively compare outcomes after LITT versus craniotomy for regrowing lesions in patients previously treated with SRS for brain metastases.
Data were collected from a single-institution chart review of patients treated with LITT or craniotomy for previously irradiated brain metastasis.
Of 75 patients, 42 had recurrent tumor (56%) and 33 (44%) had RN. Of patients with tumor, 26 underwent craniotomy and 16 LITT. For RN, 15 had craniotomy and 18 LITT. There was no significant difference between LITT and craniotomy in ability to taper off steroids or neurological outcomes. Progression-free survival (PFS) and overall survival (OS) were similar for LITT versus craniotomy, respectively: %PFS-survival at 1-year = 72.2% versus 61.1%, %PFS-survival at 2-years = 60.0% versus 61.1%, p = 0.72; %OS-survival at 1-year = 69.0% versus 69.3%, %OS-survival at 2-years = 56.6% versus 49.5%, p = 0.90. Craniotomy resulted in higher rates of pre-operative deficit improvement than LITT (p < 0.01). On subgroup analysis, the single factor most significantly associated with OS and PFS was pathology of the lesion. About 40% of tumor lesions needed post-operative salvage with radiation after both craniotomy and LITT.
LITT was as efficacious as craniotomy in achieving local control of recurrent irradiated brain metastases and facilitating steroid taper, regardless of pathology. Craniotomy appears to be more advantageous for providing symptom relief in those with pre-operative symptoms.
许多出版物报道激光间质热疗（LITT）是治疗放射性坏死（RN）和立体定向放射外科（SRS）治疗脑转移后再生长肿瘤的可行替代治疗方法。迄今为止，尚无研究比较这两种选择。本研究的目的是回顾性比较 LITT 与开颅手术治疗 SRS 治疗脑转移后再生长病变患者的结果。
从单机构图表回顾中收集了接受 LITT 或开颅手术治疗先前接受 SRS 治疗的脑转移患者的数据。
在 75 名患者中，42 名患者有复发性肿瘤（56%），33 名（44%）有 RN。在肿瘤患者中，26 名接受了开颅手术，16 名接受了 LITT。对于 RN，15 名接受了开颅手术，18 名接受了 LITT。在停用类固醇或神经功能结果方面，LITT 和开颅手术之间没有显著差异。LITT 与开颅手术的无进展生存率（PFS）和总生存率（OS）分别相似：1 年时的%PFS-生存率为 72.2%对 61.1%，2 年时的%PFS-生存率为 60.0%对 61.1%，p=0.72；1 年时的%OS-生存率为 69.0%对 69.3%，2 年时的%OS-生存率为 56.6%对 49.5%，p=0.90。开颅手术较 LITT 改善术前缺陷的发生率更高（p<0.01）。在亚组分析中，与 OS 和 PFS 最显著相关的单一因素是病变的病理。大约 40%的肿瘤病变在 LITT 和开颅手术后需要进行放射治疗来挽救。
无论病变的病理如何，LITT 在实现复发性放射性脑转移的局部控制和促进类固醇减量方面与开颅手术同样有效。开颅手术在为术前有症状的患者提供症状缓解方面似乎更有利。
