Abstract

   Laser-interstitial thermal therapy (LITT) at the time of radiographic
   regrowth after stereotactic radiosurgery (SRS) of brain metastases
   allows lesions to be biopsied and treated simultaneously. While
   excellent post-LITT responses have been reported, indications for use
   remain unclear. This study describes the variability seen in post-LITT
   imaging changes, especially FLAIR, reflecting perilesional edema, and
   examines clinical and treatment variables that may affect post-LITT
   response. Using a novel 3D-segmentation tool created at our
   institution, we analyzed volumetric changes in both FLAIR and
   contrast-enhancing lesions before and for 12-months post-LITT across 23
   patients. Over half (57%, 13/23) of patients demonstrated an initial
   increase in FLAIR volume at 2 weeks post-LITT and 43% demonstrated
   stable or decreased FLAIR. For those with an initial decrease, their
   percentage volume change from 0 to 0.5 months ranged from 21% to 67%,
   while those with an initial increase, percentage volume change varied
   from 2.6% to 254%. Of the 13 patients with an initial increase in
   FLAIR, 6 had FLAIR resolution over the subsequent 6-12 weeks. Four
   patients did not show FLAIR resolution until 12 months. Of the 10
   patients with initial decrease, 6 had resolution of FLAIR signal
   abnormality by 3 months and 9 by 6 months. At 12 months, in those
   patients with an initial FLAIR increase, only 54% showed a decrease in
   enhancing lesion volume compared to 70% of patients with an initial
   decrease in FLAIR. No clinical or treatment factors were statistically
   associated with any pattern of lesional change although trends were
   seen with pre-LITT size and immunotherapy use. Survival was found to be
   associated with biopsy pathology. This study demonstrates FLAIR changes
   after LITT can be even more variable than for contrast enhancing lesion
   volumes. A larger study is needed to determine clinical and treatment
   factors that contribute to early favorable responses to LITT.
     __________________________________________________________________

   Articles from Neuro-Oncology Advances are provided here courtesy of
   Oxford University Press
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