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. 2023 Apr 28:3:101749.
doi: 10.1016/j.bas.2023.101749. eCollection 2023.

Stereotactic laser ablation in neuro-oncology - A survey among European neurosurgeons

Ilaria Viozzi  1 , Maroeska M Rovers  2 , Christiaan G Overduin  2 , Mark Ter Laan  1
Affiliations

Stereotactic laser ablation in neuro-oncology - A survey among European neurosurgeons

Ilaria Viozzi et al. Brain Spine. .

Abstract

Introduction: In the last decades, the application of stereotactic laser ablation (SLA) for the treatment of intracranial tumours has been growing, even though comparative trials are lacking. Our aim was to investigate the familiarity with SLA of neurosurgeons in Europe and their opinion regarding potential neuro-oncological indications. Furthermore, we investigated treatment preferences and variability for three exemplar neuro-oncological cases and willingness to refer for SLA.

Material and methods: A 26-questions survey was mailed to members of the EANS neuro-oncology section. We presented three clinical cases of respectively deep-seated glioblastoma, recurrent metastasis and recurrent glioblastoma. Descriptive statistics was applied to report results.

Results: 110 respondents completed all questions. Recurrent glioblastoma and recurrent metastases were regarded as the most feasible indications for SLA (chosen by 69% and 58% of the respondents) followed by newly diagnosed high-grade gliomas (31%). Seventy percent of respondents would refer patients for SLA. The majority of respondents would consider SLA as a treatment option for all three presented cases: 79% for the deep-seated glioblastoma case, 65% for the recurrent metastasis case and 76% for the recurrent glioblastoma case. Among respondents who wouldn't consider SLA, preference for standard treatment and lack of clinical evidence were reported as the main reasons.

Conclusions: Most of respondents considered SLA as a treatment option for recurrent glioblastoma, recurrent metastases and newly diagnosed deep-seated glioblastoma. At the moment the current evidence to support such a treatment is very low. Comparative prospective trials are needed to support the use of SLA and determine proper indications.

Keywords: Glioblastoma; Neuro-oncology; Stereotactic laser ablation; Survey.

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Conflict of interest statement

The authors declare the following interests/personal relationships which may be considered as potential competing interests: We (IV, CO, ML) have previously been supported (in kind and financially) by Medtronic (r) for performing a laser ablation pilot trial (Grant ERP-2020-12244). Currently all authors are involved in a government funded RCT on laser ablations in glioblastoma, NCT05318612.

Figures

Fig. 1
Fig. 1
nGBM case - A 40 years old male presents with a lesion in the thalamus. A stereotactic biopsy has been performed and histopathological analysis shows a IDH wild type glioblastoma (WHO gr 4). No targetable mutations were found. Patient has a Karnofsky performance score of 90. Current MRI with gadolinium is shown (A: axial; B: sagittal; C: coronal). Possible treatment choices were: surgical resection, chemotherapy and radiotherapy, best supportive care.
Fig. 2
Fig. 2
nMeta case - A 55-years old female presents with a recurrent solitary brain metastasis from a mamma carcinoma, six months after resection and local fractionated radiotherapy. Patient has otherwise stable disease without other metastases. She has a Karnofsky Performance Score of 90. Current MRI with gadolinium is shown (A: axial; B: sagittal; C: coronal). Possible treatment choices were: surgical repeated resection, systemic or immunotherapy, best supportive care.
Fig. 3
Fig. 3
rGBM case - A 55-years old male presents with recurrent glioblastoma, six months after surgical resection and temozolomide/radiotherapy (Stupp protocol). No targetable mutations were found. Patient has a Karnofsky Performance Score of 90. Current MRI is shown. Possible treatment choices were: repeated resection, second line chemotherapy, best supportive care.
Fig. 4
Fig. 4
Overview of indications for SLA according to our respondents. Multiple answers were possible. Number of respondents: 123.
Fig. 5
Fig. 5
Would you consider SLA for the three cases? Number of respondents: 110. nGBM: newly diagnosed glioblastoma; rMeta: recurrent metastasis; rGBM: recurrent glioblastoma.
See this image and copyright information in PMC

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