Laser interstitial thermal therapy for new and recurrent meningioma: a prospective and retrospective case series

Veronica L Chiang; Sangami Pugazenthi; William A Leidig; Analiz Rodriguez; Sujit Prabhu; Aden P Haskell-Mendoza; Peter E Fecci; Dimitris G Placantonakis; Steven R Abram; Bradley Lega; Albert H Kim

doi:10.3171/2023.12.JNS231542

Laser interstitial thermal therapy for new and recurrent meningioma: a prospective and retrospective case series

J Neurosurg. 2024 Mar 8:1-11. doi: 10.3171/2023.12.JNS231542. Online ahead of print.

Authors

Affiliations

¹ 1Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut.
² 2Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri.
³ 3Department of Neurosurgery, University of Arkansas for Medical Sciences Medical Center, Little Rock, Arkansas.
⁴ 4University of Texas MD Anderson Cancer Center, Houston, Texas.
⁵ 5Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina.
⁶ 6Department of Neurosurgery, NYU Grossman School of Medicine, New York, New York.
⁷ 7Department of Neurosurgery, Ascension St. Thomas Hospital West, Nashville, Tennessee.
⁸ 8Department of Neurosurgery, University of Texas Southwestern Medical Center, Dallas, Texas; and.
⁹ 9The Brain Tumor Center, Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri.

PMID: 38457795
DOI: 10.3171/2023.12.JNS231542

Abstract

Objective: Meningiomas are the most common primary brain tumors in adults and a subset are aggressive lesions resistant to standard therapies. Laser interstitial thermal therapy (LITT) has been successfully applied to other brain tumors, and recent work aims to explore the safety and long-term outcome experiences of LITT for both new and recurrent meningiomas. The authors' objective was to report safety and outcomes data of the largest cohort of LITT-treated meningioma patients to date.

Methods: Eight United States-based hospitals enrolled patients with meningioma in the Laser Ablation of Abnormal Neurological Tissue Using Robotic NeuroBlate System (LAANTERN) prospective multicenter registry and/or contributed additional retrospective enrollments for this cohort study. Demographic, procedural, safety, and outcomes data were collected and analyzed using standard statistical methods.

Results: Twenty adult patients (12 prospective and 8 retrospective) with LITT-targeted meningiomas were accrued. Patients underwent LITT for new (6 patients) and recurrent (14 patients) tumors (ranging from the 1st to 12th recurrence). The 30-day complication rate was 10%. Twenty percent of patients (4/20) had exhausted all other treatment options. Median length of follow-up was 1.3 years. One-third of new (2/6) and one-half of recurrent (7/14) meningiomas had disease progression during follow-up. One-year estimated local control (LC), progression-free survival, and overall survival rates were 55.3%, 48.4%, and 86.3%, respectively. In the 12 patients who had ≥ 91% ablative coverage, 1-year estimated LC was 61.4%. The complication rate was 10% (2/20), with 1 complication being transient and resolving postoperatively.

Conclusions: This cohort study supports the safety of the procedure for this tumor type. LITT can offer a much-needed treatment option, especially for patients with multiply recurrent meningiomas who have limited remaining alternatives.

Keywords: brain tumor; laser interstitial thermal therapy; meningioma; stereotactic laser ablation.