Stereotactic Laser Ablation of High-Grade Gliomas

Ammar H. Hawasli, M.D., Ph.D.; Albert H. Kim, M.D., Ph.D.; Gavin P. Dunn, M.D., Ph.D.; David D. Tran, M.D., Ph.D.; Eric C. Leuthardt, M.D.

Disclosures

Neurosurg Focus. 2014;37(6):e1 

In This Article

Abstract and Introduction

Abstract

Evolving research has demonstrated that surgical cytoreduction of a high-grade glial neoplasm is an important factor in improving the prognosis of these difficult tumors. Recent advances in intraoperative imaging have spurred the use of stereotactic laser ablation (laser interstitial thermal therapy [LITT]) for intracranial lesions. Among other targets, laser ablation has been used in the focal treatment of high-grade gliomas (HGGs). The revived application of laser ablation for gliomas parallels major advancements in intraoperative adjuvants and groundbreaking molecular advances in neuro-oncology. The authors review the research on stereotactic LITT for the treatment of HGGs and provide a potential management algorithm for HGGs that incorporates LITT in clinical practice.

Introduction

Gliomas account for 28% of the nearly 70,000 primary brain tumors diagnosed in the US annually.[14,18,53] Most gliomas are classified as high-grade gliomas (HGGs): anaplastic gliomas (WHO Grade III) and glioblastomas multiforme ([GBMs], WHO Grade IV). High-grade gliomas represent 80% of malignant primary brain tumors.[14,18,53] In spite of intensive research over the past several decades, overall prognosis for HGGs remains poor.[72] Although we have learned a great deal about the molecular and cellular biology of malignant glioma over the last decade, we have much work to do to translate our scientific understanding into improved therapeutic approaches.[10,11,50,52,72,77] More aggressive resections have been shown to play a role in improving clinical outcomes.[11,12,37,42,61] Although extent of resection is important, this is always counterbalanced against the potential for functional impairments associated with surgery, which can also reduce the overall prognosis.[25,37,43] New technologies that enable an improved balance between tumor cytoreduction and the need to preserve relevant brain function are emerging. Specifically, MRI-guided laser interstitial thermal therapy (LITT) is becoming an important surgical tool for treatment of HGGs in several clinical contexts. In this work we review the technology, clinical experience with, and general indications for LITT, along with emerging applications of this approach.

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