The clinical data and guidelines support traditional GTR as the standard of care for both newly diagnosed and, occasionally, for recurrent tumors. However, data presented in this review suggest that LITT may serve as a viable focal treatment option for HGG in patients who are not candidates for open resection. The literature currently available is Level IV evidence without case-matched controls. Therefore, although results are promising, conclusions remain limited. The mixed results for LITT for HGGs are probably due to many factors including mixed patient cohorts, a lack of control data, treatment factors, tumor grades, concurrent therapies, and a combination of recurrence and newly diagnosed tumors. When evaluated as a subgroup, recurrent tumors appeared to have a median survival time potentially better than historical controls, but case-controlled data are currently unavailable. To date, subgroup analysis of de novo treatment for newly diagnosed tumors is less conclusive. Going forward, LITT may be incorporated into a rigorous patient treatment algorithm used by multidisciplinary neuro-oncology groups to better refine and understand clinical efficacy and indications.
Abbreviations used in this paper
BBB = blood-brain barrier; BCNU = carmustine; GBM = glioblastoma multiforme; GTR = gross-total resection; HGG = high-grade glioma; KPS = Karnofsky Performance Scale; LITT = laser interstitial thermal therapy.
We acknowledge support from the Department of Neurosurgery, Washington University School of Medicine.
Neurosurg Focus. 2014;37(6):e1 © 2014 American Association of Neurological Surgeons