Magnetic resonance-guided laser interstitial thermal therapy for recurrent glioblastoma and radiation necrosis: a single-surgeon case series.

OBJECTIVE: Evaluate long-term clinical outcomes among patients treated with laser interstitial thermal therapy (LITT) for predicted recurrent glioblastoma (rGBM).

METHODS: Patients with rGBM treated by LITT by a single surgeon (2013-2020) were evaluated for progression-free survival (PFS), overall survival (OS), and OS after LITT.

RESULTS: Forty-nine patients (33 men, 16 women; mean [SD] age at diagnosis, 58.7 [12.5] years) were evaluated. Among patients with genetic data, 6 of 34 (18%) had IDH-1 R132 mutations, and 7 of 21 (33%) had MGMT methylation. Patients underwent LITT at a mean (SD) 23.8 (23.8) months after original diagnosis. Twenty of 49 (40%) had previous stereotactic radiosurgery, 37 (75%) intensity-modulated radiation therapy, and 49 (100%) chemotherapy. Patients had a mean 1.2 (0.7) previous resections before LITT. Mean preoperative enhancing and T2 FLAIR volumes were 13.1 (12.8) cm3 and 35.0 (32.8) cm3 , respectively. Intraoperative biopsies confirmed rGBM in 31 (63%) and radiation necrosis in 18 (37%). Six perioperative complications occurred: 3 (6%) cases of worsening aphasia, 1 (2%) seizure, 1 (2%) epidural hematoma, and 1 (2%) intraparenchymal hemorrhage. For the rGBM group, median PFS was 2.0 (IQR, 4.0) months, median OS was 20.0 (IQR, 29.5) months, and median OS after LITT was 6.0 (IQR, 10.5) months. For the radiation necrosis group, median PFS was 4.0 (IQR, 4.5) months, median OS was 37.0 (IQR, 58.0) months, and median OS after LITT was 8.0 (IQR, 23.5) months.

CONCLUSIONS: In a diverse rGBM cohort, LITT was associated with a short duration of posttreatment PFS.