According to findings from the prospective multicenter LAANTERN study reported by Leuthardt et al in the Journal of Clinical Oncology, laser interstitial thermal therapy (LITT) may offer a minimally invasive cytoreductive option for selected patients with primary and metastatic brain tumors, with outcomes influenced by the extent of ablation and tumor size. The study represents the largest prospective evaluation of LITT for intracranial tumors to date.
Study Details
The LAANTERN registry prospectively collected real-world data from patients treated with LITT using the NeuroBlate System at 25 U.S. centers between 2015 and 2023. The current analysis included patients with primary or metastatic brain tumors or radiation necrosis. Patients were followed for up to 5 years, and investigators collected demographic, procedural, adverse event, survival, and quality-of-life data. Overall survival and progression-free survival were evaluated using Kaplan-Meier analyses.
Among the 787 patients included in the analysis, 445 (56.5%) had primary brain tumors and 342 (43.5%) had metastatic lesions. The median patient age was 59.6 years, and the median follow-up was 12 months. The median hospital stay was 32.4 hours, and 62.6% of patients avoided admission to an intensive care unit. Near-total ablation of at least 91% was achieved in 75.5% of primary tumors and 85.9% of metastatic tumors.
Key Results
Among 69 patients with newly diagnosed glioblastoma, median overall survival was 1.2 years (95% confidence interval [CI] = 0.6–2.1 years) and median progression-free survival was 0.5 years (95% CI = 0.3–1.1 years). Patients with newly diagnosed glioblastoma who achieved at least 91% ablation had significantly longer median progression-free survival (1.32 vs 0.24 years, P < .0001) and overall survival (2.1 vs 0.36 years, P < .0001) than those with ≤ 90% ablation.
Among patients with recurrent metastatic tumors, median post-LITT overall survival was 2.02 years (95% CI = 1.33–2.68 years) and median progression-free survival was 0.70 years (95% CI = 0.49–1.05 years). Achieving 100% ablation was associated with longer post-LITT overall survival compared with ablation of 99% or less (2.8 vs 1.3 years, P = .03). Smaller lesion size was also associated with outcomes: recurrent metastatic tumors measuring less than 7.9 cc had a median progression-free survival of 1.2 years vs 0.5 years for larger lesions (P = .001).
The overall adverse event rate was 12.8%; 65.5% of events resolved completely, and the risk of severe or irreversible adverse events was 2.3%. Two procedure-related deaths occurred (one case of edema and one of hemorrhage), corresponding to a surgical mortality rate of 0.25%.
The authors concluded: “The data from this largest, prospective LITT cohort support the consideration of LITT as a cytoreductive tool for patients with primary and metastatic tumor with short hospital stays, low complication rates, and preserved functional status. The [extent of ablation] in glioblastoma and lesion volume in metastatic disease emerge as factors that may guide patient selection.”
Eric C. Leuthardt, MD, MBA, of the Department of Neurosurgery, Washington University, St. Louis, Missouri, is the corresponding author for the Journal of Clinical Oncology article.
DISCLOSURE: The study was supported by Monteris Medical Corporation. For full disclosures of the study authors, visit ascopubs.org.
