MR-guided laser-induced thermal therapy (LITT) for recurrent glioblastomas
MR-guided laser-induced thermal therapy (LITT) for recurrent glioblastomas
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DOI：
10.1002/lsm.22025
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发表时间：
2012-07-01
影响因子：
2.4
通讯作者：
Delattre, Jean-Yves
中科院分区：
文献类型：
--
作者：
Carpentier, Alexandre;Chauvet, Dorian;Delattre, Jean-Yves
背景与目的磁共振热成像（MRTI）引导下的激光诱导热疗（LITT）是一种微创、安全的治疗脑肿瘤，尤其是脑转移瘤的方法。我们在这里报告我们的经验，使用这种治疗复发性胶质母细胞瘤。材料与方法4例胶质母细胞瘤患者，年龄40 ~ 58岁。经全切除、化疗和放疗后复发。由于每例患者都不适合进行第二次手术，因此建议将LITT作为挽救治疗。在立体定向引导下，将光纤施加器插入肿瘤内，在连续MRI下进行LITT。实时反馈控制的基础上的磁共振成像，以评估质量的局部组织破坏，以防止不必要的损害附近的结构。结果手术耐受性良好，无神经功能恶化。在短期随访中，发生了1例一过性辅助运动区综合征、1例癫痫发作和1例脑脊液漏。所有这些都得到了成功的管理。术后MRI显示无并发症，治疗体积令人满意，治疗肿瘤大小减小。对于所有患者，观察到复发，平均/中位无进展生存期为37/30天。LITT后的平均/中位总生存期为10.5/10个月。结论微创LITT结合实时MRTI控制是一种安全的局灶性肿瘤控制方法。如果认为1天的治疗对几周的生存期增加有用，则可以将LITT视为高级别复发性胶质瘤的挽救治疗。需要更多的经验来定义这种浸润性疾病的适应症，并准确确定与这种1天手术相关的良好神经系统状况下的潜在显著生存率增加。激光外科医学44：361368，2012年。(c)2012 Wiley Periodicals，Inc.
Background and objective Laser-induced thermal therapy (LITT), coupled with magnetic resonance thermal imaging (MRTI) guidance, provides a minimally invasive and safe approach to treat brain tumors, especially metastases. We report here our experience using this treatment for recurrent glioblastomas. Materials and Methods Four patients, from 40 to 58 years old, were diagnosed with glioblastoma. After total resection, chemotherapy and radiation therapy, recurrence occurred. As each was ineligible for a second surgery, LITT was proposed as salvage therapy. Under stereotactic guidance, a fiberoptic applicator was inserted within the tumor LITT was performed under continuous MRTI. Real-time feedback control based on MRTI was employed to assess the quality of local tissue destruction and to prevent unwanted damage to nearby structures. Results The procedure was well tolerated with no peroperative neurological deterioration. In the short-term follow-up, one transient supplementary motor area syndrome, one epileptic seizure, and one cerebrospinal fluid leakage occurred. All were successfully managed. Post-procedure MRI showed no complication, satisfying treatment volume, and a decrease in size of the treated tumor. For all patients, recurrence was observed with a mean/median progression free survival of 37/30 days. Mean/median overall survival after LITT was 10.5/10 months. Conclusion Focal tumor control was performed safely using minimally invasive LITT with real-time MRTI control. LITT could be considered as salvage therapy for high-grade recurrent gliomas if a 1-day treatment is considered useful for a few weeks gain in survival. Larger experience will be required to define indications for such infiltrative disease and accurately determine a potentially significant survival gain in good neurological condition associated with this 1-day procedure. Lasers Surg. Med. 44: 361368, 2012. (c) 2012 Wiley Periodicals, Inc.