Laser interstitial thermal therapy for recurrent brain metastases following stereotactic radiosurgery: a systematic review.

Abstract

Introduction: Laser Interstitial Thermal Therapy (LITT) has emerged as a promising minimally invasive treatment option for recurrent brain metastases, especially for patients who have previously undergone Stereotactic Radiosurgery (SRS). Despite its growing use, additional research is needed to explore its utility and safety in this population.

Methods: This systematic review evaluates the literature on LITT for recurrent brain metastases post-SRS, including patient selection, treatment protocols, outcomes, and complications. The review was registered with PROSPERO (CRD42024577899) and followed the PRISMA 2020 guidelines.

Results: Seventeen studies, encompassing 694 patients, met our inclusion criteria. The median overall survival (OS) across these studies was 14.4 months with an average 12-month OS of 60.1%. Notably, median OS was 5.9 months after LITT alone and 12.7 months when LITT was followed by adjuvant SRS. The pooled local control rate was 75.6% at 6 months and 72.2% at 12 months.

Conclusion: LITT is a minimally invasive treatment option that has shown potential in managing recurrent brain metastases after prior SRS, particularly when biopsy is required to differentiate between tumor recurrence and radiation necrosis. However, data on the comparative efficacy and cost-effectiveness of LITT versus alternative treatments such as repeat SRS or craniotomy remain limited.