激光间质热疗治疗新发和复发性脑膜瘤：一项前瞻性和回顾性病例系列研究。

Laser interstitial thermal therapy for new and recurrent meningioma: a prospective and retrospective case series.

机构信息

1Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut.

2Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri.

出版信息

J Neurosurg. 2024 Mar 8;141(3):642-652. doi: 10.3171/2023.12.JNS231542. Print 2024 Sep 1.

DOI:10.3171/2023.12.JNS231542

PMID:38457795

Abstract

OBJECTIVE

Meningiomas are the most common primary brain tumors in adults and a subset are aggressive lesions resistant to standard therapies. Laser interstitial thermal therapy (LITT) has been successfully applied to other brain tumors, and recent work aims to explore the safety and long-term outcome experiences of LITT for both new and recurrent meningiomas. The authors' objective was to report safety and outcomes data of the largest cohort of LITT-treated meningioma patients to date.

METHODS

Eight United States-based hospitals enrolled patients with meningioma in the Laser Ablation of Abnormal Neurological Tissue Using Robotic NeuroBlate System (LAANTERN) prospective multicenter registry and/or contributed additional retrospective enrollments for this cohort study. Demographic, procedural, safety, and outcomes data were collected and analyzed using standard statistical methods.

RESULTS

Twenty adult patients (12 prospective and 8 retrospective) with LITT-targeted meningiomas were accrued. Patients underwent LITT for new (6 patients) and recurrent (14 patients) tumors (ranging from the 1st to 12th recurrence). The 30-day complication rate was 10%. Twenty percent of patients (4/20) had exhausted all other treatment options. Median length of follow-up was 1.3 years. One-third of new (2/6) and one-half of recurrent (7/14) meningiomas had disease progression during follow-up. One-year estimated local control (LC), progression-free survival, and overall survival rates were 55.3%, 48.4%, and 86.3%, respectively. In the 12 patients who had ≥ 91% ablative coverage, 1-year estimated LC was 61.4%. The complication rate was 10% (2/20), with 1 complication being transient and resolving postoperatively.

CONCLUSIONS

This cohort study supports the safety of the procedure for this tumor type. LITT can offer a much-needed treatment option, especially for patients with multiply recurrent meningiomas who have limited remaining alternatives.

摘要

目的

脑膜瘤是成年人中最常见的原发性脑肿瘤，其中一部分是对标准治疗具有抗药性的侵袭性病变。激光间质热疗（LITT）已成功应用于其他脑肿瘤，最近的工作旨在探索 LITT 治疗新发性和复发性脑膜瘤的安全性和长期结果经验。作者的目的是报告迄今为止最大的 LITT 治疗脑膜瘤患者队列的安全性和结果数据。

方法

8 家美国医院在激光消融异常神经组织使用机器人神经 Blate 系统（LAANTERN）前瞻性多中心登记处招募脑膜瘤患者，并/或为该队列研究提供了额外的回顾性登记。使用标准统计方法收集和分析人口统计学、程序、安全性和结果数据。

结果

共纳入 20 名接受 LITT 靶向治疗的脑膜瘤成年患者（12 名前瞻性和 8 名回顾性）。患者接受 LITT 治疗新发（6 例）和复发性（14 例）肿瘤（范围从第 1 次到第 12 次复发）。30 天并发症发生率为 10%。20%的患者（4/20）已用尽所有其他治疗选择。中位随访时间为 1.3 年。三分之一的新发（2/6）和一半的复发性（7/14）脑膜瘤在随访期间出现疾病进展。1 年估计局部控制（LC）、无进展生存率和总生存率分别为 55.3%、48.4%和 86.3%。在 12 名接受≥91%消融覆盖的患者中，1 年估计 LC 为 61.4%。并发症发生率为 10%（2/20），其中 1 例并发症为短暂性，术后缓解。