Lessons Learned in Using Laser Interstitial Thermal Therapy for Treatment of Brain Tumors: A Case Series of 238 Patients from a Single Institution.
BACKGROUND
Laser interstitial thermal therapy (LITT) is a novel, minimally invasive alternative to craniotomy, and as with any new technology, comes with a learning curve.


OBJECTIVE
We present our experience detailing the evolution of this technology in our practice in one of the largest patient cohorts to date regarding LITT in neuro-oncology.


METHODS
We reviewed 238 consecutive patients with brain tumor treated with LITT at our institution. Data on patient, surgery and tumor characteristics, and follow-up were collected. Patients were categorized into 2 cohorts: early (<2014, 100 patients) and recent (>2015, 138 patients). Median follow-up for the entire cohort was 8.4 months.


RESULTS
The indications for LITT included gliomas (70.2%), radiation necrosis (21.0%), and metastasis (8.8%). Patient demographics stayed consistent between the 2 cohorts, with the exception of age (early, 54.3; recent, 58.4; P = 0.04). Operative time (6.6 vs. 3.5; P < 0.001) and number of trajectories (53.1% vs. 77.9% with 1 trajectory; P < 0.001) also decreased in the recent cohort. There was a significant decrease in permanent motor deficits over time (15.5 vs. 4.4%; P = 0.005) and 30-day mortality (4.1% vs. 1.5%) also decreased (not statistically significant) in the recent cohort. In terms of clinical outcomes, poor preoperative Karnofsky Performance Status (≤70) were significantly correlated with increased permanent deficits (P = 0.001) and decreased overall survival (P < 0.001 for all time points).


CONCLUSIONS
We observed improvement in operative efficiency and permanent deficits over time and also patients with poor preoperative Karnofsky Performance Status achieved suboptimal outcomes with LITT. As many other treatment modalities, patient selection is important in this procedure.
['Shao|Jianning|J|', 'Radakovich|Nathan R|NR|', 'Grabowski|Matthew|M|', 'Borghei-Razavi|Hamid|H|', 'Knusel|Konrad|K|', 'Joshi|Krishna C|KC|', "Muhsen|Baha'eddin A|BA|", 'Hwang|Lee|L|', 'Barnett|Gene H|GH|', 'Mohammadi|Alireza M|AM|']
D000328:Adult D000368:Aged D001932:Brain Neoplasms D015331:Cohort Studies D003131:Combined Modality Therapy D005260:Female D005500:Follow-Up Studies D005910:Glioma D006801:Humans D017567:Karnofsky Performance Status D053685:Laser Therapy D008297:Male D008875:Middle Aged D019060:Minimally Invasive Surgical Procedures D009069:Movement Disorders D009362:Neoplasm Metastasis D061646:Operative Time D018579:Patient Selection D011183:Postoperative Complications D016019:Survival Analysis D016896:Treatment Outcome
Tumor Minimally invasive Glioma Radiation necrosis Glioblastoma Stereotactic laser ablation