• Neurosurgery · Jun 2022

    Multicenter Study

    Time to Steroid Independence After Laser Interstitial Thermal Therapy vs Medical Management for Treatment of Biopsy-Proven Radiation Necrosis Secondary to Stereotactic Radiosurgery for Brain Metastasis.

    • Eric W Sankey, Matthew M Grabowski, Ethan S Srinivasan, Andrew S Griffin, Elizabeth P Howell, Balint Otvos, Vadim Tsvankin, Gene H Barnett, Alireza M Mohammadi, and Peter E Fecci.
    • Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA.
    • Neurosurgery. 2022 Jun 1; 90 (6): 684-690.

    BackgroundRadiation necrosis (RN) after stereotactic radiosurgery (SRS) for brain metastases (BM) can result in significant morbidity, compounded by the effects of extended steroid therapy. Laser interstitial thermal therapy (LITT) is a minimally invasive procedure that can offer definitive treatment for RN while potentially obviating the need for prolonged steroid use.ObjectiveTo compare LITT vs medical management (MM) in the treatment of RN.MethodsA multicenter, retrospective study was performed of SRS-treated patients with BM who developed biopsy-proven RN and were treated with LITT or MM. Clinical outcome data were compared by treatment modality.ResultsSeventy-two patients met criteria with a median follow-up of 10.0 months (4.2-25.1), and 57 patients (79%) underwent LITT. Four MM (27%) and 3 LITT patients (5%) demonstrated radiographic progression (P = .031) at a median of 5.3 and 4.0 months (P = .40). There was no significant difference in overall survival (LITT median of 15.2 vs 11.6 months, P = .60) or freedom from local progression (13.6 vs 7.06 months, P = .40). Patients stopped steroid therapy earlier in the LITT cohort at a median of 37 days compared with 245 days (P < .001). When controlled for follow-up duration, patients treated with LITT were 3 times more likely to be weaned off steroids before the study end point (P = .003).ConclusionThese data suggest that LITT for treatment of biopsy-proven RN after SRS for BM significantly decreases time to steroid independence. Prospective trials should be designed to further validate the utility of LITT for RN and its impact on steroid-induced morbidity.Copyright © Congress of Neurological Surgeons 2022. All rights reserved.

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