目的:脑膜瘤是成人最常见的原发性脑肿瘤,一部分是对标准疗法有抗性的侵袭性病变。激光间质热疗(LITT)已成功应用于其他脑肿瘤,最近的工作旨在探索LITT治疗新发和复发性脑膜瘤的安全性和长期结局。作者的目的是报告迄今为止最大的LITT治疗脑膜瘤患者队列的安全性和结果数据。
方法:八家美国医院在使用机器人神经支配系统(LAANTERN)前瞻性多中心注册的异常神经组织激光消融中招募了脑膜瘤患者和/或为该队列研究提供了额外的回顾性注册。人口统计,程序,安全,和结局数据收集和分析采用标准统计学方法.
结果:20例成人患者(12例前瞻性和8例回顾性)LITT靶向脑膜瘤。患者接受LITT新(6例)和复发(14例)肿瘤(第1至第12例复发)。30天并发症发生率为10%。20%的患者(4/20)已经用尽了所有其他治疗选择。中位随访时间为1.3年。三分之一的新脑膜瘤(2/6)和一半的复发性脑膜瘤(7/14)在随访期间疾病进展。一年估计本地控制(LC),无进展生存期,总生存率为55.3%,48.4%,和86.3%,分别。在12例消融覆盖率≥91%的患者中,1年估计LC为61.4%。并发症发生率为10%(2/20),1例并发症是短暂的,术后缓解。
结论:该队列研究支持该肿瘤类型手术的安全性。LITT可以提供急需的治疗选择,特别是对于多例复发性脑膜瘤患者,他们的选择有限。
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.