Stereotactic laser ablation as treatment for brain metastases that recur after stereotactic radiosurgery: A multiinstitutional experience

Mir Amaan Ali, Kate T. Carroll, Robert C. Rennert, Thomas Hamelin, Leon Chang, Brian P. Lemkuil, Mayur Sharma, Jill S. Barnholtz-Sloan, Charlotte Myers, Gene H. Barnett, Kris Smith, Alireza M. Mohammadi, Andrew E. Sloan, Clark C. Chen

Research output: Contribution to journalArticlepeer-review

28 Scopus citations

Abstract

Objective Therapeutic options for brain metastases (BMs) that recur after stereotactic radiosurgery (SRS) remain limited. Methods The authors provide the collective experience of 4 institutions where treatment of BMs that recurred after SRS was performed with stereotactic laser ablation (SLA). Results Twenty-six BMs (in 23 patients) that recurred after SRS were treated with SLA (2 patients each underwent 2 SLAs for separate lesions, and a third underwent 2 serial SLAs for discrete BMs). Histological findings in the BMs treated included the following: breast (n = 6); lung (n = 6); melanoma (n = 5); colon (n = 2); ovarian (n = 1); bladder (n = 1); esophageal (n = 1); and sarcoma (n = 1). With a median follow-up duration of 141 days (range 64-794 days), 9 of the SLA-treated BMs progressed despite treatment (35%). All cases of progression occurred in BMs in which < 80% ablation was achieved, whereas no disease progression was observed in BMs in which ≥ 80% ablation was achieved. Five BMs were treated with SLA, followed 1 month later by adjuvant SRS (5 Gy daily × 5 days). No disease progression was observed in these patients despite ablation efficiency of < 80%, suggesting that adjuvant hypofractionated SRS enhances the efficacy of SLA. Of the 23 SLA-treated patients, 3 suffered transient hemiparesis (13%), 1 developed hydrocephalus requiring temporary ventricular drainage (4%), and 1 patient who underwent SLA of a 28.9-cm3 lesion suffered a neurological deficit requiring an emergency hemicraniectomy (4%). Although there is significant heterogeneity in corticosteroid treatment post-SLA, most patients underwent a 2-week taper. Conc lusions Stereotactic laser ablation is an effective treatment option for BMs in which SRS fails. Ablation of = 80% of BMs is associated with decreased risk of disease progression. The efficacy of SLA in this setting may be augmented by adjuvant hypofractionated SRS.

Original languageEnglish (US)
Article numberE11
JournalNeurosurgical focus
Volume41
Issue number4
DOIs
StatePublished - 2016

Keywords

  • Brain metastases
  • Neurooncology
  • Real-time MR
  • Stereotactic laser ablation

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