Fomchenko Elena I, Leelatian Nalin, Darbinyan Armine, Huttner Anita J, Chiang Veronica L
Departments of1Neurosurgery and.
2Pathology, Yale School of Medicine, New Haven, Connecticut.
J Neurosurg Case Lessons. 2022 Jul 4;4(1):CASE21373. doi: 10.3171/CASE21373.
Patients with lung cancer and melanoma remain the two largest groups to develop brain metastases. Immunotherapy has been approved for treatment of stage IV disease in both groups. Many of these patients are additionally treated with stereotactic radiosurgery for their brain metastases during ongoing immunotherapy. Use of immunotherapy has been reported to increase the rates of radiation necrosis (RN) after radiosurgery, causing neurological compromise due to growth of the enhancing lesion as well as worsening of associated cerebral edema.
Laser interstitial thermal therapy (LITT) is a surgical approach that has been shown effective in the management of RN, especially given its efficacy in early reduction of perilesional edema. However, little remains known about the pathology of the post-LITT lesions and how LITT works in this condition. Here, we present two patients who needed surgical decompression after LITT for RN. Clinical, histopathological, and imaging features of both patients are presented.
Criteria for selecting the best patients with RN for LITT therapy remains unclear. Given two similarly sized lesions and not too dissimilar clinical histories but with differing outcomes, further investigation is clearly needed to identify predictors of response to LITT in the setting of SRS and immunotherapy-induced RN.
肺癌和黑色素瘤患者仍是发生脑转移的两大主要群体。免疫疗法已被批准用于治疗这两类患者的IV期疾病。许多此类患者在进行免疫治疗期间，还因其脑转移接受了立体定向放射外科治疗。据报道，使用免疫疗法会增加放射外科治疗后放射性坏死（RN）的发生率，由于强化病灶的生长以及相关脑水肿的加重，导致神经功能受损。
激光间质热疗（LITT）是一种手术方法，已被证明在治疗RN方面有效，特别是考虑到其在早期减轻病灶周围水肿方面的疗效。然而，关于LITT术后病变的病理学以及LITT在这种情况下的作用机制，人们了解甚少。在此，我们介绍两名在接受LITT治疗RN后需要手术减压的患者。展示了两名患者的临床、组织病理学和影像学特征。
选择最适合接受LITT治疗的RN患者的标准仍不明确。鉴于两个大小相似且临床病史差异不大但结果不同的病灶，显然需要进一步研究以确定在立体定向放射外科和免疫疗法诱导的RN背景下对LITT反应的预测因素。
