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Comparative Study
. 2019 Dec 1;85(6):762-772.
doi: 10.1093/neuros/nyy449.

Upfront Magnetic Resonance Imaging-Guided Stereotactic Laser-Ablation in Newly Diagnosed Glioblastoma: A Multicenter Review of Survival Outcomes Compared to a Matched Cohort of Biopsy-Only Patients

Alireza M Mohammadi  1 , Mayur Sharma  1 , Thomas L Beaumont  2 , Kevin O Juarez  3 , Hanna Kemeny  4 , Cosette Dechant  4 , Andreas Seas  4 , Nehaw Sarmey  1 , Bryan S Lee  1 , Xuefei Jia  5 , Peter E Fecci  4 , Joachim Baehring  3 , Jennifer Moliterno  3 , Veronica L Chiang  3 , Manmeet S Ahluwalia  1 , Albert H Kim  2 , Gene H Barnett  1 , Eric C Leuthardt  2   6   7
Affiliations
Comparative Study

Upfront Magnetic Resonance Imaging-Guided Stereotactic Laser-Ablation in Newly Diagnosed Glioblastoma: A Multicenter Review of Survival Outcomes Compared to a Matched Cohort of Biopsy-Only Patients

Alireza M Mohammadi et al. Neurosurgery. .

Abstract

Background: Laser ablation (LA) is used as an upfront treatment in patients with deep seated newly diagnosed Glioblastoma (nGBM).

Objective: To evaluate the outcomes of LA in patients with nGBM and compare them with a matched biopsy-only cohort.

Methods: Twenty-four nGBM patients underwent upfront LA at Cleveland clinic, Washington University in St. Louis, and Yale University (6/2011-12/2014) followed by chemo/radiotherapy. Also, 24 out of 171 nGBM patients with biopsy followed by chemo/radiotherapy were matched based on age (< 70 vs ≥ 70), gender, tumor location (deep vs lobar), and volume (<11 cc vs ≥11 cc). Progression-free survival (PFS), overall survival (OS), and disease-specific PFS and OS were outcome measures. Three prognostic groups were identified based on extent of tumor ablation by thermal-damage-threshold (TDT)-lines.

Results: The median tumor volume in LA (n = 24) and biopsy only (n = 24) groups was 9.3 cm3 and 8.2 cm3 respectively. Overall, median estimate of OS and PFS in LA cohort was 14.4 and 4.3 mo compared to 15.8 mo and 5.9 mo for biopsy only cohort. On multivariate analysis, favorable TDT-line prognostic groups were associated with lower incidence of disease specific death (P = .03) and progression (P = .05) compared to other groups including biopsy only cohort. Only age (<70 yr, P = .02) and tumor volume (<11 cc, P = .03) were favorable prognostic factors for OS.

Conclusion: The maximum tumor coverage by LA followed by radiation/chemotherapy is an effective treatment modality in patients with nGBM, compared to biopsy only cohort. The TDT-line prognostic groups were independent predictor of disease specific death and progression after LA.

Keywords: Brain tumor; GBM; LITT; Minimally invasive; NeuroBlate; Novel treatment.

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Figures

FIGURE 1.
FIGURE 1.
Treatment of right frontal tumor using LA. A, yellow TDT-line (defined as the tumor tissue that has been heated to 43°C for 2 min) and B, blue TDT-line (defined as tumor heated to 43°C for 10 min).
FIGURE 2.
FIGURE 2.
TDT-line risk groups and tumor volume. Two patients with tumor volumes >20 cm3 (42.33 and 62.78) were recoded to 28 for ease of presentation.
FIGURE 3.
FIGURE 3.
TDT-line prognostic groups and its effect on 4 different outcomes in comparison with biopsy only patients. A , OS; B , DSOS; C , PFS; D , DSPFS.
See this image and copyright information in PMC

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