SURG-09 - Emily Lerner.mp4

Benefits of laser interstitial thermal therapy in the treatment of biopsy-proven radiation necrosis

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Emily Lerner1, Ethan Srinivasan1, Eric Sankey1, Matthew Grabowski2, Andrew Griffin1, Elizabeth Howell1, Balint Otvos1, Vadim Tsvankin1, Ahmet Akit2, Krishna Joshi2, Gene Barnett2, Peter Fecci1, Alireza Mohammadi2

1Duke University School of Medicine, Durham, NC, USA. 2The Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA

INTRODUCTION: Laser interstitial thermal therapy (LITT) is a minimally-invasive treatment option often used for patients with deep-seated intracranial lesions. It has been implemented as a definitive treatment for radiation necrosis (RN), which occurs in 9-14% of patients after stereotactic radiosurgery (SRS) for brain metastases (BM). Medical management (MM) with steroids is a common first-line therapy, with variable response and numerous side effects, especially regarding immunotherapy.

METHODS: Patients with biopsy-proven RN after SRS for BM who received LITT or MM at two academic centers were retrospectively reviewed. Treatment failure was defined as radiographic progression that necessitated a change in management. Measurements of total (TLV) and contrast-enhancing lesion volume (ceLV) were obtained from MRI by semi-automated analysis using the BrainLab iPlan Cranial 3.0 software.

RESULTS: Seventy-two patients were followed for 10.0 (4.2-25.1) months and 57 (79%) received LITT. Steroid cessation occurred at a median of 37 days post-LITT compared to 245 days after MM (p<0.01). The MM group did not demonstrate any statistically significant radiographic trends.

CONCLUSION: These results suggest that LITT for RN significantly reduces the time to steroid cessation and characterize a stereotyped radiographic response to LITT. Future prospective studies will be important to their validation.

Duration: 04:10

Posted: Monday, August 9, 2021

Video tags: 3rd Annual Conference on Brain Metastases - Pre-Records