Article
Image-guided LITT as a minimal invasive procedure in the treatment of callosa gliomas
MR gesteuerte LITT als minimal-invasive Methode in der Behandlung von Balkengliomen
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Published: | May 4, 2005 |
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Outline
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Objective
The majority of gliomas affecting the corpus callosum are classified as bein unsuitable for open microsurgery. Depending on the neuropathological findings of a stereotactic biopsy, there is no therapeutic option for the benign tumors; malignant gliomas receive radiation and chemotherapy as a palliative standard. As a new option of minimal invasive therapy, we introduced the MR-guided laser-induced interstitial thermotherapy (LITT) for these cases. It offers a relatively safe method of partial cytoreduction in the region of corpus callosum. A (palliative) reduction of tumor growth can be achieved. As examples for the application of LITT in benign and malignant gliomas affecting the corpus callosum, two patients are demonstrated:
- A 42-year-old woman with a benign astrocytoma (II° WHO) of the anterior and middle parts of the corpus callosum was treated in 1999 (Karnofsky Index 100)
- A 56-year-old woman with a recurrent glioblastoma of the posterior corpus callosum was treated three times in 2003; a simultaneous chemotherapy (temozolomide) was added and repeated monthly.
Methods
Laser irradiation was performed using a Nd:YAG laser (1064 nm). The light was transmitted via a light guide ending in an optical diffusion tip which was positioned in the centre of the tumor. The mean energy delivered per laser session was 4.5±0.7 kJ. Laser therapy was guided by MR-imaging. For the positioning of the light guide, a special localization system 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 tumors.
Results
LITT was tolerated well without major complications. The benign glioma (astrocytoma II° WHO), treated once in '99, showed a stepwise change of its whole inner structure in the MR-follow-up during more than five years. A minor paresis of the hand even vanished. The primarily fast-growing, radiated glioblastoma of the posterior corpus callosum was treated three times in 2000; the tumor growth stopped, a partial cytoreduction was achieved for 9 months, the patient died from a general infection under corticoids 10 months after the first "LITT".
Conclusions
The LITT can be used as a safe and repeatable minimal invase therapy in "non-surgical candidates" suffering from benign and malignant gliomas affecting the corpus callosum. Survival time can be increased, preserving a good quality of life.