title: Laser thermal therapy: real-time MRI-guided and computer-controlled procedures for metastatic brain tumors.
abstract: OBJECTIVE
  We report the final results of a pilot clinical trial exploring the safety and feasibility of real-time magnetic resonance-guided laser-induced thermal therapy (MRgLITT) for treatment of resistant focal metastatic intracranial tumors.
  
  
  METHODS
  In patients with chemotherapy, whole-brain radiation, and radiosurgery resistant metastatic intracranial tumors, minimally invasive stereotaxic placement of a saline-cooled interstitial fiberoptic laser applicator under local anesthesia was followed by laser irradiation during continuous magnetic resonance imaging (MRI) scanning. A computer workstation extracted real-time temperature-sensitive information for feedback control over laser delivery. A total of 15 metastatic tumors were treated in 7 patients. Patients were followed with physical exam and imaging for 30 months.
  
  
  RESULTS
  In all cases, the procedure was well tolerated, and patients were discharged home within 24 hours. Follow-up imaging at up to 30 months showed an acute increase in apparent lesion volume followed by a gradual and steady decrease. No tumor recurrence within thermal ablation zones was noted. Kaplan-Meier analysis indicated that the median survival was 19.8 months.
  
  
  CONCLUSIONS
  Real-time magnetic resonance (MR) guidance of laser-induced thermal therapy (LITT) offers a high level of control. This tool therefore enables a minimally invasive option for destruction and treatment of resistant focal metastatic intracranial tumors. MR-guided LITT appears to provide a safe and potentially effective treatment for recurrent focal metastatic brain disease. A larger phase II and III series would be of interest to quantify potential median survival advantage.
authors: Department of Neurosurgery, Hopital Lariboisiere and Pitié Salpetriere, Assistance Publique - Hôpitaux de Paris, France. alexandre.carpentier@psl.aphp.fr
authors: Alexandre
authors: A
authors: Carpentier
authors: Roger J
authors: RJ
authors: McNichols
authors: R Jason
authors: RJ
authors: Stafford
authors: Jean-Pierre
authors: JP
authors: Guichard
authors: Daniel
authors: D
authors: Reizine
authors: Suzette
authors: S
authors: Delaloge
authors: Eric
authors: E
authors: Vicaut
authors: Didier
authors: D
authors: Payen
authors: Ashok
authors: A
authors: Gowda
authors: Bernard
authors: B
authors: George
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D001932:Brain Neoplasms / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D001943:Breast Neoplasms / Q000473:pathology; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D053685:Laser Therapy / Q000295:instrumentation / Q000379:methods*; D054023:Lasers, Semiconductor / Q000627:therapeutic use*; D008175:Lung Neoplasms / Q000473:pathology; D053783:Magnetic Resonance Imaging, Interventional; D008875:Middle Aged; D010865:Pilot Projects; D011183:Postoperative Complications; D025321:Surgery, Computer-Assisted; D016019:Survival Analysis; D016896:Treatment Outcome