Expedited chemoradiation after laser interstitial thermal therapy (LITT) is feasible and safe in patients with newly diagnosed glioblastoma

Abstract

Background: High-grade gliomas (HGG) are incurable primary brain tumors. Laser interstitial thermal therapy (LITT) has emerged as an alternative to surgery for select patients. Hyperthermia can improve the efficacy of radiation and chemotherapy. Shortening the time between LITT and chemoradiation may maximize their biological and clinical benefits. This trial evaluated the safety and feasibility of expediting chemoradiation after biopsy and LITT in patients with newly diagnosed HGG.

Methods: Patients with suspected HGG were enrolled. Those with pathologic confirmation of HGG and deemed appropriate candidates for LITT and chemoradiation were considered evaluable. Participants underwent 6 weeks of adjuvant chemoradiation initiated within 7 days of LITT. Endpoints were assessed until the completion of radiation and included the occurrence of wound dehiscence; new, treatment-refractory seizures; cerebral edema; and completion of planned radiotherapy.

Results: Thirteen patients with suspected HGG were enrolled, and ten were considered evaluable. All 10 patients were diagnosed with glioblastoma (GBM, IDHwt). Three patients were deemed unevaluable: 2 patients with other CNS tumors and one GBM patient who developed grade 4 postoperative edema. Of 10 evaluable patients, the median age was 60.2 years (IQR: 51.0, 69.4), and median preoperative KPS was 90 (IQR: 90, 80). The median time between LITT and the initiation of chemoradiation was 7 days. There were no occurrences of significant protocol-related adverse events.

Conclusions: Accelerated initiation of chemoradiation after biopsy and LITT is safe and feasible for patients with newly diagnosed GBM. A larger study is needed to assess potential synergy of hyperthermia and chemoradiation to improve survival.

Keywords: complications; expedited chemoradiation; laser interstitial thermal therapy; newly diagnosed glioblastoma; survival.

Figure 1.

Clinical trial schema. Patients with suspected HGG were evaluated by the multi-disciplinary team and enrolled in the study if eligible. Biopsy was performed at the time of LITT. If the biopsy supported a diagnosis of HGG, patients received LITT. Upon confirmation of the diagnosis, patients went on to receive radiation and temozolomide within 7 days of LITT. Patients went on to receive maintenance temozolomide. If the biopsy did not support a diagnosis of HGG, patients came off study.