目的:评估接受激光间质热疗(LITT)治疗的患者预测复发性胶质母细胞瘤(rGBM)的长期临床结果。
方法:单外科医生(2013-2020年)对接受LITT治疗的rGBM患者进行无进展生存期(PFS)评估,总生存期(OS),LITT后的OS。
结果:49名患者(33名男性,16名女性;诊断时的平均[SD]年龄,58.7[12.5]年)进行了评估。在有基因数据的患者中,34人中有6人(18%)有IDH-1R132突变,21人中有7人(33%)出现MGMT甲基化。患者在最初诊断后平均(SD)23.8(23.8)个月接受LITT。49人中有20人(40%)曾接受过立体定向放射外科手术,37(75%)调强放射治疗,49(100%)化疗。患者在LITT之前进行了平均1.2(0.7)次切除。术前平均增强和T2FLAIR体积分别为13.1(12.8)cm3和35.0(32.8)cm3。术中活检证实31例(63%)rGBM和18例(37%)放射性坏死。围手术期并发症6例:失语症恶化3例(6%),1次(2%)癫痫发作,1例(2%)硬膜外血肿,1例(2%)脑实质出血。对于rGBM组,中位PFS为2.0(IQR,4.0)months,中位OS为20.0(IQR,29.5)月,LITT后的中位OS为6.0(IQR,10.5)月。对于放射性坏死组,中位PFS为4.0(IQR,4.5)months,中位OS为37.0(IQR,58.0)个月,LITT后的中位OS为8.0(IQR,23.5)月。
结论:在不同的rGBM队列中,LITT与治疗后PFS持续时间短相关。
To evaluate long-term clinical outcomes among patients treated with laser interstitial thermal therapy (LITT) for predicted recurrent glioblastoma (rGBM).
Patients with rGBM treated by LITT by a single surgeon (2013-2020) were evaluated for progression-free survival (PFS), overall survival (OS), and OS after LITT.
Forty-nine patients (33 men, 16 women; mean [SD] age at diagnosis, 58.7 [12.5] years) were evaluated. Among patients with genetic data, 6 of 34 (18%) had IDH-1 R132 mutations, and 7 of 21 (33%) had MGMT methylation. Patients underwent LITT at a mean (SD) of 23.8 (23.8) months after original diagnosis. Twenty of 49 (40%) had previously undergone stereotactic radiosurgery, 37 (75%) had undergone intensity-modulated radiation therapy, and 49 (100%) had undergone chemotherapy. Patients had undergone a mean of 1.2 (0.7) previous resections before LITT. Mean preoperative enhancing and T2 FLAIR volumes were 13.1 (12.8) cm3 and 35.0 (32.8) cm3, respectively. Intraoperative biopsies confirmed rGBM in 31 patients (63%) and radiation necrosis in 18 patients (37%). Six perioperative complications occurred: 3 (6%) cases of worsening aphasia, 1 (2%) seizure, 1 (2%) epidural hematoma, and 1 (2%) intraparenchymal hemorrhage. For the rGBM group, median PFS was 2.0 (IQR, 4.0) months, median OS was 20.0 (IQR, 29.5) months, and median OS after LITT was 6.0 (IQR, 10.5) months. For the radiation necrosis group, median PFS was 4.0 (IQR, 4.5) months, median OS was 37.0 (IQR, 58.0) months, and median OS after LITT was 8.0 (IQR, 23.5) months.
In a diverse rGBM cohort, LITT was associated with a short duration of posttreatment PFS.