Sankey Eric W, Grabowski Matthew M, Srinivasan Ethan S, Griffin Andrew S, Howell Elizabeth P, Otvos Balint, Tsvankin Vadim, Barnett Gene H, Mohammadi Alireza M, Fecci Peter E
Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA.
Department of Neurosurgery, Cleveland Clinic and Case Comprehensive Cancer Center, Cleveland, Ohio, USA.
Neurosurgery. 2022 Jun 1;90(6):684-690. doi: 10.1227/neu.0000000000001922. Epub 2022 Mar 23.
Radiation necrosis (RN) after stereotactic radiosurgery (SRS) for brain metastases (BM) can result in significant morbidity, compounded by the effects of extended steroid therapy. Laser interstitial thermal therapy (LITT) is a minimally invasive procedure that can offer definitive treatment for RN while potentially obviating the need for prolonged steroid use.
To compare LITT vs medical management (MM) in the treatment of RN.
A multicenter, retrospective study was performed of SRS-treated patients with BM who developed biopsy-proven RN and were treated with LITT or MM. Clinical outcome data were compared by treatment modality.
Seventy-two patients met criteria with a median follow-up of 10.0 months (4.2-25.1), and 57 patients (79%) underwent LITT. Four MM (27%) and 3 LITT patients (5%) demonstrated radiographic progression (P = .031) at a median of 5.3 and 4.0 months (P = .40). There was no significant difference in overall survival (LITT median of 15.2 vs 11.6 months, P = .60) or freedom from local progression (13.6 vs 7.06 months, P = .40). Patients stopped steroid therapy earlier in the LITT cohort at a median of 37 days compared with 245 days (P < .001). When controlled for follow-up duration, patients treated with LITT were 3 times more likely to be weaned off steroids before the study end point (P = .003).
These data suggest that LITT for treatment of biopsy-proven RN after SRS for BM significantly decreases time to steroid independence. Prospective trials should be designed to further validate the utility of LITT for RN and its impact on steroid-induced morbidity.
脑转移瘤（BM）立体定向放射外科治疗（SRS）后发生的放射性坏死（RN）可导致严重的发病率，长期使用类固醇治疗的影响会使情况更加复杂。激光间质热疗（LITT）是一种微创手术，可为RN提供确定性治疗，同时可能避免长期使用类固醇。
比较LITT与药物治疗（MM）在RN治疗中的效果。
对接受SRS治疗且发生经活检证实的RN并接受LITT或MM治疗的BM患者进行了一项多中心回顾性研究。通过治疗方式比较临床结局数据。
72例患者符合标准，中位随访时间为10.0个月（4.2 - 25.1个月），57例患者（79%）接受了LITT治疗。4例MM患者（27%）和3例LITT患者（5%）在中位时间5.3个月和4.0个月时出现影像学进展（P = 0.031）（P = 0.40）。总生存期（LITT组中位生存期为15.2个月，MM组为11.6个月，P = 0.60）或无局部进展生存期（分别为13.6个月和7.06个月，P = 0.40）无显著差异。LITT组患者停用类固醇治疗的时间更早，中位时间为37天，而MM组为245天（P < 0.001）。在控制随访时间后，接受LITT治疗的患者在研究终点前停用类固醇的可能性是MM组的3倍（P = 0.003）。
这些数据表明，LITT用于治疗BM的SRS后经活检证实的RN可显著缩短类固醇停用时间。应设计前瞻性试验以进一步验证LITT对RN的效用及其对类固醇诱导的发病率的影响。
