Laser thermal therapy: Real‐time MRI‐guided and computer‐controlled procedures for metastatic brain tumors

Lasers in Surgery and Medicine - Tập 43 Số 10 - Trang 943-950 - 2011
Alexandre Carpentier1,2, Roger J. McNichols3, R. Jason Stafford4, Jean‐Pierre Guichard5, D Reizine5, Suzette Delaloge6, Éric Vicaut7, Didier Payen2, Ashok Gowda3, Bernard George2
1Advanced Surgical Technologies Research Team, Université Paris VI, Paris, France
2Department of Neurosurgery, Hopital Lariboisiere and Pitié Salpetriere, Assistance Publique – Hôpitaux de Paris, Paris, France
3BioTex, Inc., Houston, Texas
4Department of Imaging Physics, University of Texas M. D. Anderson Cancer Center, Houston, Texas
5Department of Neuroradiology, Hopital Lariboisiere, Assistance Publique – Hôpitaux de Paris, Université Paris VII, Paris, France
6Breast Oncologie Department, Institut Gustave Roussy, Villejuif, France
7Clinical Research Unit, CEDEM Hôpital Fernand Widal, Assistance Publique – Hôpitaux de Paris, Université Paris VII, Paris, France

Tóm tắt

AbstractBackground and ObjectiveWe report the final results of a pilot clinical trial exploring the safety and feasibility of real‐time magnetic resonance‐guided laser‐induced thermal therapy (MRgLITT) for treatment of resistant focal metastatic intracranial tumors.Study DesignIn patients with chemotherapy, whole‐brain radiation, and radiosurgery resistant metastatic intracranial tumors, minimally invasive stereotaxic placement of a saline‐cooled interstitial fiberoptic laser applicator under local anesthesia was followed by laser irradiation during continuous magnetic resonance imaging (MRI) scanning. A computer workstation extracted real‐time temperature‐sensitive information for feedback control over laser delivery. A total of 15 metastatic tumors were treated in 7 patients. Patients were followed with physical exam and imaging for 30 months.ResultsIn all cases, the procedure was well tolerated, and patients were discharged home within 24 hours. Follow‐up imaging at up to 30 months showed an acute increase in apparent lesion volume followed by a gradual and steady decrease. No tumor recurrence within thermal ablation zones was noted. Kaplan–Meier analysis indicated that the median survival was 19.8 months.ConclusionReal‐time magnetic resonance (MR) guidance of laser‐induced thermal therapy (LITT) offers a high level of control. This tool therefore enables a minimally invasive option for destruction and treatment of resistant focal metastatic intracranial tumors. MR‐guided LITT appears to provide a safe and potentially effective treatment for recurrent focal metastatic brain disease. A larger phase II and III series would be of interest to quantify potential median survival advantage. Lasers Surg. Med. 43:943–950, 2011. © 2011 Wiley Periodicals, Inc.

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Tài liệu tham khảo

10.1001/jama.280.17.1485

10.1227/01.NEU.0000311254.63848.72

Ascher PW, 1991, Interstitial thermotherapy of central brain tumors with the Nd:YAG laser under real‐time monitoring by MRI, J Clin Laser Med Surg, 9, 79, 10.1089/clm.1991.9.79

10.1007/978-3-7091-9160-6_23

10.1097/00004728-199407000-00002

10.1080/01616412.1992.11740073

Sakai T, 1992, Interstitial laserthermia in neurosurgery, J Clin Laser Med Surg, 10, 37, 10.1089/clm.1992.10.37

10.1002/jmri.1880080140

10.1097/00004728-199709000-00031

10.1002/jmri.20446

10.1055/s-2001-13581

10.1002/mrm.1910210116

10.1002/mrm.1910340313

10.1002/mrm.1910330111

10.1002/mrm.1910340606

10.1002/lsm.20069

10.1080/02656730310001611035

10.1002/lsm.10243

10.1007/978-1-4757-6092-7_22

Derosier C, 1991, MRI stereotaxis choice of an approach route on an independent console, J Neuroradiol, 18, 333

Dawson‐Saunders B, 1994, Basic and clinical biostatistics, 188

10.1016/S0360-3016(96)00619-0

10.1016/S0360-3016(99)00549-0

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Thông tin xuất bản

Lasers in Surgery and Medicine

Tập 43 Số 10

943-950

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