Fernandes Dias Sandra, Oertel Markus F, Guerreiro Stücklin Ana, Gerber Nicolas U, Colombo Elisa, van Doormaal Tristan P C, Krayenbühl Niklaus
Division of Pediatric Neurosurgery, University Children's Hospital Zurich - Eleonoren Foundation, Zurich, Switzerland.
Department of Neurosurgery and Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
Front Surg. 2025 Jan 17;11:1462074. doi: 10.3389/fsurg.2024.1462074. eCollection 2024.
The use of magnetic resonance-guided laser interstitial thermal therapy (LITT) for the treatment of brain tumors and epileptic lesions has increased in the field of pediatric neurosurgery. However, very little is known about the effect of LITT on pediatric high-grade tumors that have been previously treated with radiotherapy. We report on two cases of children with an unexpected rapid brain tumor progression after LITT. The first case was an 11-year-old boy with a periventricular metastasis of a recurrent anaplastic ependymoma treated with proton-therapy and radiosurgery. The second case was a 6-year-old girl with a Lynch-syndrome and a recurrence of a mesio-temporo-occipital high-grade glioma admitted to gross total resection, proton-therapy, chemotherapy, bevacizumab and immune checkpoint inhibitor. Due to evidence of tumor progression in both cases, a decision was made to perform LITT. Shortly after the laser ablation, we observed a significant tumor growth along the trajectory of the LITT catheters, accompanied by clinical deterioration. The effect of LITT on pediatric ependymoma and high-grade glioma recurrence after radiotherapy is still unclear. The tumor expansion following LITT in these two patients should drive a deeper awareness of the effect of radiation and LITT on the tumor-environment. The breakage of the morphogenetic boundaries of the neuromeres, to which each tumor was initially confined, through the placement of the LITT catheters should be considered while trying to understand the disease spread mechanisms. Based on the experience of our center, we advise a careful implementation of this technique on pediatric high-grade central nervous system tumors, particularly in recurrent tumors that were previously treated with radiotherapy, until the underlying pathophysiologic mechanism has been better understood.
在小儿神经外科领域，磁共振引导激光间质热疗（LITT）用于治疗脑肿瘤和癫痫病灶的应用有所增加。然而，对于先前接受过放疗的小儿高级别肿瘤，LITT的效果却知之甚少。我们报告了两例LITT后出现意外快速脑肿瘤进展的儿童病例。第一例是一名11岁男孩，患有复发性间变性室管膜瘤的脑室周围转移，接受过质子治疗和放射外科手术。第二例是一名6岁女孩，患有林奇综合征，颞枕叶高级别胶质瘤复发，接受了全切除、质子治疗、化疗、贝伐单抗和免疫检查点抑制剂治疗。由于两例均有肿瘤进展的证据，决定进行LITT。激光消融后不久，我们观察到沿LITT导管轨迹有明显的肿瘤生长，并伴有临床恶化。LITT对放疗后小儿室管膜瘤和高级别胶质瘤复发的影响仍不清楚。这两名患者LITT后的肿瘤扩张应促使人们更深入地认识放疗和LITT对肿瘤环境的影响。在试图理解疾病传播机制时，应考虑到通过放置LITT导管打破每个肿瘤最初局限的神经节段形态发生边界的情况。基于我们中心的经验，在尚未更好地理解潜在病理生理机制之前，我们建议在小儿高级别中枢神经系统肿瘤，尤其是先前接受过放疗的复发性肿瘤中谨慎应用这项技术。
