Artikel
Laser-induced interstitial thermotherapy of recurrent glioblastomas
Laser induzierte interstitielle Thermotherapie von Glioblastomrezidiven
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Autoren
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W. von Tempelhoff
- Department of Medical Neurosurgery, Klinikum Krefeld, University of Düsseldorf Medical School at Krefeld
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H. Niehoff
- Department of Medical Neurosurgery, Klinikum Krefeld, University of Düsseldorf Medical School at Krefeld
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H.-J. Schwarzmaier
- Department of Medical Technology, Klinikum Krefeld, University of Düsseldorf Medical School at Krefeld
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V. Fiedler
- Department of Radiology, Klinikum Krefeld, University of Düsseldorf Medical School at Krefeld
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F. Ulrich
- Department of Medical Neurosurgery, Klinikum Krefeld, University of Düsseldorf Medical School at Krefeld
| Veröffentlicht: | 4. Mai 2005 |
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Gliederung
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Objective
The prognosis of a recurrent glioblastoma is poor. Although new chemotherapy regimens have recently been introduced, the mean survival of these patients is reported to be not longer than three to five months. Therefore, new therapies are required. In this study, we employed laser-induced interstitial thermotherapy (LITT) for a partial cytoreduction in these patients.
Methods
In total, 16 Patients (mean age 62±5.7 yrs) were treated by interstitial laser irradiation. All patients suffered from a histologically confirmed recurrent glioblastoma grade WHO IV and were non-surgical candidates. In all patients, at least one laser treatment was performed. Laser irradiation was performed using a Nd:YAG laser (?=1064 nm, cw, 4060 N, Dornier Medizintechnik, Germering, Germany). The light was transmitted via a light guide ending in an optical diffusion tip (LITT Standard-Applicator, Trumpf, Umkirch, Germany) which was positioned in the centre of the tumour. The mean energy delivered per laser session was 4.5±0.7 kJ. Laser therapy was guided by MR-imaging (SIGNA SP/I, General Electric, Milwaukee, WI). For the positioning of the light guide, the built in localization system (Flashpoint 3000, IGT, Boulder, CO) was used. Thermal therapy was guided by MR thermometry using an experimental software package based on the phase shift technique. Follow-up MR examinations exhibited a volume decrease of the irradiated parts of the tumours.
Results
All patients tolerated the procedure well and there was no in-hospital mortality. Major complications were not observed. Minor complications were a transient paresis in 3 cases. The mean survival of the patients was 9.2 months after the diagnosis of a recurrent glioblastomas and 6.8 months after the first LITT. The cause of death was in most cases related to pulmonary embolism and adverse effects of chemotherapy and/or corticosteroids.
Conclusions
Partial cytoreduction using LITT is feasible and safe in recurrent glioblastoma multiforme. The data showed a tendency towards an increased survival. However, controlled clinical trials are required to define the role of LITT in the clinical management of recurrent glioblastoma.
