Stereotactic laser ablation as treatment for brain metastases that recur after stereotactic radiosurgery: a multiinstitutional experience.
OBJECTIVE Therapeutic options for brain metastases (BMs) that recur after stereotactic radiosurgery (SRS) remain limited. METHODS The authors provide the collective experience of 4 institutions where treatment of BMs that recurred after SRS was performed with stereotactic laser ablation (SLA). RESULTS Twenty-six BMs (in 23 patients) that recurred after SRS were treated with SLA (2 patients each underwent 2 SLAs for separate lesions, and a third underwent 2 serial SLAs for discrete BMs). Histological findings in the BMs treated included the following: breast (n = 6); lung (n = 6); melanoma (n = 5); colon (n = 2); ovarian (n = 1); bladder (n = 1); esophageal (n = 1); and sarcoma (n = 1). With a median follow-up duration of 141 days (range 64-794 days), 9 of the SLA-treated BMs progressed despite treatment (35%). All cases of progression occurred in BMs in which < 80% ablation was achieved, whereas no disease progression was observed in BMs in which ≥ 80% ablation was achieved. Five BMs were treated with SLA, followed 1 month later by adjuvant SRS (5 Gy daily × 5 days). No disease progression was observed in these patients despite ablation efficiency of < 80%, suggesting that adjuvant hypofractionated SRS enhances the efficacy of SLA. Of the 23 SLA-treated patients, 3 suffered transient hemiparesis (13%), 1 developed hydrocephalus requiring temporary ventricular drainage (4%), and 1 patient who underwent SLA of a 28.9-cm3lesion suffered a neurological deficit requiring an emergency hemicraniectomy (4%). Although there is significant heterogeneity in corticosteroid treatment post-SLA, most patients underwent a 2-week taper. CONCLUSIONS Stereotactic laser ablation is an effective treatment option for BMs in which SRS fails. Ablation of ≥ 80% of BMs is associated with decreased risk of disease progression. The efficacy of SLA in this setting may be augmented by adjuvant hypofractionated SRS.
Departments of 1 Neurosurgery.
Mir Amaan
MA
Ali
Departments of 1 Neurosurgery.
Kate T
KT
Carroll
Departments of 1 Neurosurgery.
Robert C
RC
Rennert
Radiology, and.
Thomas
T
Hamelin
Anesthesia, University of California, San Diego, California.
Leon
L
Chang
Anesthesia, University of California, San Diego, California.
Brian P
BP
Lemkuil
Department of Neurosurgery, The Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, and.
Mayur
M
Sharma
Department of Neurosurgery, University Hospitals, Cleveland, Ohio; and.
Jill S
JS
Barnholtz-Sloan
Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona.
Charlotte
C
Myers
Department of Neurosurgery, The Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, and.
Gene H
GH
Barnett
Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona.
Kris
K
Smith
Department of Neurosurgery, The Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, and.
Alireza M
AM
Mohammadi
Department of Neurosurgery, University Hospitals, Cleveland, Ohio; and.
Andrew E
AE
Sloan
Departments of 1 Neurosurgery.
Clark C
CC
Chen
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000556:secondary* / Q000601:surgery*; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D053685:Laser Therapy / Q000379:methods*; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D016634:Radiosurgery / Q000009:adverse effects*; D013238:Stereotaxic Techniques
D000305:Adrenal Cortex Hormones
BM = brain metastasis; BNI = Barrow Neurological Institute; CC = Cleveland Clinic; CW = Case Western; QID = 4 times daily; SLA = stereotactic laser ablation; SRS = stereotactic radiosurgery; TID = 3 times daily; UCSD = University of California San Diego; brain metastases; neurooncology; real-time MRI; stereotactic laser ablation