Laser Ablation of Abnormal Neurological Tissue Using Robotic NeuroBlate System (LAANTERN): 12-Month Outcomes and Quality of Life After Brain Tumor Ablation

Abstract

Background: Laser Ablation of Abnormal Neurological Tissue using Robotic NeuroBlate System (LAANTERN) is an ongoing multicenter prospective NeuroBlate (Monteris Medical) LITT (laser interstitial thermal therapy) registry collecting real-world outcomes and quality-of-life (QoL) data.

Objective: To compare 12-mo outcomes from all subjects undergoing LITT for intracranial tumors/neoplasms.

Methods: Demographics, intraprocedural data, adverse events, QoL, hospitalizations, health economics, and survival data are collected; standard data management and monitoring occur.

Results: A total of 14 centers enrolled 223 subjects; the median follow-up was 223 d. There were 119 (53.4%) females and 104 (46.6%) males. The median age was 54.3 yr (range 3-86) and 72.6% had at least 1 baseline comorbidity. The median baseline Karnofsky Performance Score (KPS) was 90. Of the ablated tumors, 131 were primary and 92 were metastatic. Most patients with primary tumors had high-grade gliomas (80.9%). Patients with metastatic cancer had recurrence (50.6%) or radiation necrosis (40%). The median postprocedure hospital stay was 33.4 h (12.7-733.4). The 1-yr estimated survival rate was 73%, and this was not impacted by disease etiology. Patient-reported QoL as assessed by the Functional Assessment of Cancer Therapy-Brain was stabilized postprocedure. KPS declined by an average of 5.7 to 10.5 points postprocedure; however, 50.5% had stabilized/improved KPS at 6 mo. There were no significant differences in KPS or QoL between patients with metastatic vs primary tumors.

Conclusion: Results from the ongoing LAANTERN registry demonstrate that LITT stabilizes and improves QoL from baseline levels in a malignant brain tumor patient population with high rates of comorbidities. Overall survival was better than anticipated for a real-world registry and comparative to published literature.

Trial registration: ClinicalTrials.gov NCT02392078.

Keywords: Brain tumor; LITT; Laser ablation; Quality of life; Survival.

Graphical Abstract

FIGURE 1.

Tumor types. There were 131 primary tumors and 92 metastatic tumors. Other primary tumors included: “other” primary tumor included tuberous sclerosis (5), teratoma (2), cavernous malformation (1), craniopharyngioma (1), gliosis (1), ganglioglioma (1), or not specified/categorized.

FIGURE 2.

Overall survival by tumor type. Kaplan-Meier curves estimate overall survival through 24-mo follow-up. A, Survival in the overall tumor cohort was 73.0% at 12 mo. B, Survival for patients with primary vs metastatic tumors was 74.6% and 70.7% at 12 mo, respectively (P = .2581). There was no difference in 12-mo survival in patients with new vs recurrent primary tumors (P = .4831). C, Survival at 1, 3, 6, 12, and 24 mo for patients with metastatic brain tumor recurrence was 90.5%, 78.3%, 72.7%, 68.1%, and 68.1% vs for patients with radiation necrosis due to metastatic disease was 94.1%, 91.1%, 87.8%, 71.1%, and 71.1%. These differences trended toward favoring better early survival for patients with radiation necrosis; however, the differences were not statistically significant (P > .05).

FIGURE 3.

Change in FACT-Br scores. Change in FACT-Br scores was assessed from follow-up to baseline for the total tumor population. FACT-Br total score declined by 4.5 and 4.3 points (200-point scale) at 1 and 3 mo after the procedure but was stabilized by 6 and 12 mo. Emotional well-being improved at all timepoints. Functional well-being decreased at 1 mo but improved to baseline levels by 3 mo. These changes did not meet the criteria for being clinically meaningful (>10% of instrument range, ± 20 points). Per-patient analysis sample size: 1 mo, N = 145; 3 mo N = 137; 6 mo, N = 105; 12 mo, N = 75. *P < .05, **P < .001.

FIGURE 4.

Summary of patient questionnaire results. The infographic summarizes the results of the EQ-5D and FACT-Br questionnaires.