Laser ablation after stereotactic radiosurgery: a multicenter prospective study in patients with metastatic brain tumors and radiation necrosis

Laser Ablation After Stereotactic Radiosurgery (LAASR) is a multicenter prospective study of laser interstitial thermal (LITT) ablation in patients with radiographic progression after stereotactic radiosurgery for brain metastases. Patients with a Karnofsky Performance Scale (KPS) score ≥ 60, an age...

Celý popis

Uložené v:

Podrobná bibliografia
Vydané v:	Journal of neurosurgery Ročník 130; číslo 3; s. 804
Hlavní autori:	Ahluwalia, Manmeet, Barnett, Gene H, Deng, Di, Tatter, Stephen B, Laxton, Adrian W, Mohammadi, Alireza M, Leuthardt, Eric, Chamoun, Roukoz, Judy, Kevin, Asher, Anthony, Essig, Marco, Dietrich, Jorg, Chiang, Veronica L
Médium:	Journal Article
Jazyk:	English
Vydavateľské údaje:	United States 01.03.2019
Predmet:	Ablation Techniques Adult Aged Brain Neoplasms - secondary Brain Neoplasms - surgery Female Humans Karnofsky Performance Status Laser Therapy - methods Magnetic Resonance Imaging Male Middle Aged Necrosis Neoplasm Recurrence, Local Postoperative Complications - diagnostic imaging Postoperative Complications - psychology Postoperative Complications - surgery Progression-Free Survival Prospective Studies Quality of Life Radiation Injuries - diagnostic imaging Radiation Injuries - psychology Radiation Injuries - surgery Radiosurgery - adverse effects Radiosurgery - methods Treatment Outcome RANO-BM = Response Assessment in Neuro-Oncology Brain Metastases CNS = central nervous system NeuroBlate LAASR = Laser Ablation After Stereotactic Radiosurgery PFS = progression-free survival LAASR MMSE = Mini-Mental State Examination PD = progressive disease radiation necrosis PR = partial response SRS = stereotactic radiosurgery RN = radiation necrosis FACT-Br = Functional Assessment of Cancer Therapy-Brain oncology OS = overall survival laser interstitial thermal therapy LITT = laser interstitial thermal therapy Laser Ablation After Stereotactic Radiosurgery KPS = Karnofksy Performance Scale QOL = quality of life CR = complete response HVLT-R = Hopkins Verbal Learning Test–Revised metastatic brain tumor
ISSN:	1933-0693, 1933-0693
On-line prístup:	Zistit podrobnosti o prístupe
Tagy:	Pridať tag Žiadne tagy, Buďte prvý, kto otaguje tento záznam!

Popis
Shrnutí:	Laser Ablation After Stereotactic Radiosurgery (LAASR) is a multicenter prospective study of laser interstitial thermal (LITT) ablation in patients with radiographic progression after stereotactic radiosurgery for brain metastases. Patients with a Karnofsky Performance Scale (KPS) score ≥ 60, an age > 18 years, and surgical eligibility were included in this study. The primary outcome was local progression-free survival (PFS) assessed using the Response Assessment in Neuro-Oncology Brain Metastases (RANO-BM) criteria. Secondary outcomes were overall survival (OS), procedure safety, neurocognitive function, and quality of life. Forty-two patients—19 with biopsy-proven radiation necrosis, 20 with recurrent tumor, and 3 with no diagnosis—were enrolled. The median age was 60 years, 64% of the subjects were female, and the median baseline KPS score was 85. Mean lesion volume was 6.4 cm3 (range 0.4–38.6 cm3). There was no significant difference in length of stay between the recurrent tumor and radiation necrosis patients (median 2.3 vs 1.7 days, respectively). Progression-free survival and OS rates were 74% (20/27) and 72%, respectively, at 26 weeks. Thirty percent of subjects were able to stop or reduce steroid usage by 12 weeks after surgery. Median KPS score, quality of life, and neurocognitive results did not change significantly for either group over the duration of survival. Adverse events were also similar for the two groups, with no significant difference in the overall event rate. There was a 12-week PFS and OS advantage for the radiation necrosis patients compared with the recurrent tumor or tumor progression patients. In this study, in which enrolled patients had few alternative options for salvage treatment, LITT ablation stabilized the KPS score, preserved quality of life and cognition, had a steroid-sparing effect, and was performed safely in the majority of cases.
Bibliografia:	ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-1 content type line 23
ISSN:	1933-0693 1933-0693
DOI:	10.3171/2017.11.JNS171273