{"title":"Photonics in the development of personalized medicine","authors":"L. Lilge, B. Wilson","doi":"10.1515/plm-2014-0018","DOIUrl":"https://doi.org/10.1515/plm-2014-0018","url":null,"abstract":"","PeriodicalId":20126,"journal":{"name":"Photonics & Lasers in Medicine","volume":"23 1","pages":"175 - 176"},"PeriodicalIF":0.0,"publicationDate":"2014-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86593134","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Anderson Amaro dos Santos, P. Oliveira, K. Fernandes, Lara Rhon, C. Tim, F. Vasilceac, K. Z. Pinto, S. Mattiello, N. Parizotto, A. Renno
Abstract Objective: The aim of this study was to evaluate the effects of low level laser therapy (LLLT) on the degenerative process in the articular cartilage after an anterior cruciate ligament transection (ACLT) model in rats. Methods: Eighty male rats (Wistar) were divided into four groups: 1.) intact control group (CG), 2.) injured control group (ICG), 3.) injured laser-treated group at 10 J/cm2 (L10) and 4.) injured laser-treated group at 50 J/cm2 (L50). Animals were divided into 2 subgroups, with different periods of sacrifice (5 and 8 weeks post-surgery). The ACLT was used to induce osteoarthritis (OA) in the knees of the rats. LLLT started 2 weeks after the surgery and it was performed for 15 and 30 sessions, respectively using a 685-nm laser, at 10 and 50 J/cm2. Qualitative and semi-quantitative histologic, morphometric and immunohistochemistry analyses were performed. Results: Initial signs of tissue degradation could be observed 5 weeks post-ACLT, evidenced by the decrease of proteoglycan concentration and increase in cartilage thickness of the ICG. After 8 weeks post-surgery, analysis showed a progression of the degenerative processes in the ICG revealed by the increased cellularity and higher TNF-α, IL1-β and MMP-13 immunoexpression. LLLT was able to modulate some of the aspects relating to the degradative process, such as biomodulation of the number of chondrocyte proliferation, prevention of proteoglycan loss, and decrease of MMP-13 immunoexpression. Conclusion: This study showed that the 685-nm laser irradiation, especially at 10 J/cm2, prevented features related to the articular degenerative process in the knees of rats.
{"title":"Effects of low-level laser therapy on cartilage repair in an experimental model of osteoarthritis","authors":"Anderson Amaro dos Santos, P. Oliveira, K. Fernandes, Lara Rhon, C. Tim, F. Vasilceac, K. Z. Pinto, S. Mattiello, N. Parizotto, A. Renno","doi":"10.1515/plm-2013-0063","DOIUrl":"https://doi.org/10.1515/plm-2013-0063","url":null,"abstract":"Abstract Objective: The aim of this study was to evaluate the effects of low level laser therapy (LLLT) on the degenerative process in the articular cartilage after an anterior cruciate ligament transection (ACLT) model in rats. Methods: Eighty male rats (Wistar) were divided into four groups: 1.) intact control group (CG), 2.) injured control group (ICG), 3.) injured laser-treated group at 10 J/cm2 (L10) and 4.) injured laser-treated group at 50 J/cm2 (L50). Animals were divided into 2 subgroups, with different periods of sacrifice (5 and 8 weeks post-surgery). The ACLT was used to induce osteoarthritis (OA) in the knees of the rats. LLLT started 2 weeks after the surgery and it was performed for 15 and 30 sessions, respectively using a 685-nm laser, at 10 and 50 J/cm2. Qualitative and semi-quantitative histologic, morphometric and immunohistochemistry analyses were performed. Results: Initial signs of tissue degradation could be observed 5 weeks post-ACLT, evidenced by the decrease of proteoglycan concentration and increase in cartilage thickness of the ICG. After 8 weeks post-surgery, analysis showed a progression of the degenerative processes in the ICG revealed by the increased cellularity and higher TNF-α, IL1-β and MMP-13 immunoexpression. LLLT was able to modulate some of the aspects relating to the degradative process, such as biomodulation of the number of chondrocyte proliferation, prevention of proteoglycan loss, and decrease of MMP-13 immunoexpression. Conclusion: This study showed that the 685-nm laser irradiation, especially at 10 J/cm2, prevented features related to the articular degenerative process in the knees of rats.","PeriodicalId":20126,"journal":{"name":"Photonics & Lasers in Medicine","volume":"4 1","pages":"255 - 264"},"PeriodicalIF":0.0,"publicationDate":"2014-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86917173","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract MRI-guided laser interstitial thermal therapy (MRgLITT) is gaining momentum in neurosurgery and has been described to treat brain metastases, primary tumors and radiation-induced necrosis with an excellent safety profile. LITT has been also used as a minimally invasive alternative to surgical treatment of refractory epilepsy for ablating single epileptogenic foci, such as tumors, hypothalamic hamartomas, cortical dysplasia and mesial temporal sclerosis. Novelty initial experience with multi-foci epileptogenic zones and tuberosclerosis patients is also reported. As new applications for this technology are developing and variations on its use are discussed, we present a review of the current uses and results of the LITT application on brain lesions.
{"title":"MRI-guided laser interstitial thermal therapy of intracranial tumors and epilepsy: State-of-the-art review and a case study from pediatrics","authors":"Hoon Choi, Zulma Tovar-Spinoza","doi":"10.1515/plm-2014-0002","DOIUrl":"https://doi.org/10.1515/plm-2014-0002","url":null,"abstract":"Abstract MRI-guided laser interstitial thermal therapy (MRgLITT) is gaining momentum in neurosurgery and has been described to treat brain metastases, primary tumors and radiation-induced necrosis with an excellent safety profile. LITT has been also used as a minimally invasive alternative to surgical treatment of refractory epilepsy for ablating single epileptogenic foci, such as tumors, hypothalamic hamartomas, cortical dysplasia and mesial temporal sclerosis. Novelty initial experience with multi-foci epileptogenic zones and tuberosclerosis patients is also reported. As new applications for this technology are developing and variations on its use are discussed, we present a review of the current uses and results of the LITT application on brain lesions.","PeriodicalId":20126,"journal":{"name":"Photonics & Lasers in Medicine","volume":"2 1","pages":"107 - 115"},"PeriodicalIF":0.0,"publicationDate":"2014-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83673794","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Background and objectives: The use of laser interstitial thermal therapy (LITT) under magnetic resonance imaging (MRI) guidance has been reported on in the literature in close to 16,000 patients with various forms of malignant and benign neoplasms. This includes studies with over 7600 patients with malignant head and neck cancer; over 250 with malignant (and refractory to other therapies) head and neck cancer; over 6600 with liver cancer; and over 1100 with benign neoplasms. As well, LITT under MRI guidance has been studied in malignant (and refractory to other therapies) lung and breast cancers with close to 300 cases reported on in the literature. To date, the sum total experience of LITT with or without MRI guidance in treating brain neoplasms has not been reported on. It is the intention of this review to do so. Methods: A systematic review of the literature was undertaken to identify all studies where one or more patients were treated with LITT with or without MRI guidance (LITT±MRI) for brain neoplasms. The following sources were searched (from 1990 to present): PubMed, Cochrane Review of RCTs, Technology Assessment websites (NICE, CTAF, CADTH, BCBS TEC), clinical guidelines for treating malignant brain neoplasms (NCCN, AANS), relevant clinical journals where the use of LITT would be reported on; and the websites of companies involved in the manufacture and market of these types of products. Results: Twenty-three articles (22 peer-reviewed and one abstract) were identified. After duplicate studies (n=6) were removed, 17 studies with 169 patients were identified who received LITT±MRI (mean age, 54±13.3 years; ratio male/female, 66%/34%). Most patients were reported on in the literature as case series. One study however, examined use of LITT + brachytherapy in a randomized fashion. These 169 patients were further broken out by type of tumor(s) and outcomes evaluated. Ninety-nine patients were treated for glioblastoma, recurrent malignant gliomas and, recurrent glioblastomas using LITT as a follow-on/salvage therapy (average age, 58.9 years). LITT used as the sole or as adjunctive therapy appeared to prolong survival (when evaluated against historical cohorts of patients with similar baseline characteristics) versus best/palliative care in this group. This was especially true where LITT was used in brain malignancies refractory to other therapies. Twenty-four patients (average age, 40.9 years) were treated for astrocytomas (WHO I–III) and LITT was used mainly with de novo lesions in areas of inoperability/eloquence. In these tumor types, LITT appeared to be well tolerated and significantly reduced lesion size. Twenty-three patients were treated for metastatic disease (average age, 60.1 years). Equivocal benefit was found in this small cohort. All lesions treated, no matter the tumor type, in these 169 patients were ≤5 cm in diameter. Most patients underwent LITT treatment with Karnofsky index (KI) of ≥60 (where reported). Most patient
{"title":"Laser interstitial thermal therapy with and without MRI guidance for treatment of brain neoplasms – A systematic review of the literature","authors":"Jeffrey D. Voigt, M. Torchia","doi":"10.1515/plm-2013-0055","DOIUrl":"https://doi.org/10.1515/plm-2013-0055","url":null,"abstract":"Abstract Background and objectives: The use of laser interstitial thermal therapy (LITT) under magnetic resonance imaging (MRI) guidance has been reported on in the literature in close to 16,000 patients with various forms of malignant and benign neoplasms. This includes studies with over 7600 patients with malignant head and neck cancer; over 250 with malignant (and refractory to other therapies) head and neck cancer; over 6600 with liver cancer; and over 1100 with benign neoplasms. As well, LITT under MRI guidance has been studied in malignant (and refractory to other therapies) lung and breast cancers with close to 300 cases reported on in the literature. To date, the sum total experience of LITT with or without MRI guidance in treating brain neoplasms has not been reported on. It is the intention of this review to do so. Methods: A systematic review of the literature was undertaken to identify all studies where one or more patients were treated with LITT with or without MRI guidance (LITT±MRI) for brain neoplasms. The following sources were searched (from 1990 to present): PubMed, Cochrane Review of RCTs, Technology Assessment websites (NICE, CTAF, CADTH, BCBS TEC), clinical guidelines for treating malignant brain neoplasms (NCCN, AANS), relevant clinical journals where the use of LITT would be reported on; and the websites of companies involved in the manufacture and market of these types of products. Results: Twenty-three articles (22 peer-reviewed and one abstract) were identified. After duplicate studies (n=6) were removed, 17 studies with 169 patients were identified who received LITT±MRI (mean age, 54±13.3 years; ratio male/female, 66%/34%). Most patients were reported on in the literature as case series. One study however, examined use of LITT + brachytherapy in a randomized fashion. These 169 patients were further broken out by type of tumor(s) and outcomes evaluated. Ninety-nine patients were treated for glioblastoma, recurrent malignant gliomas and, recurrent glioblastomas using LITT as a follow-on/salvage therapy (average age, 58.9 years). LITT used as the sole or as adjunctive therapy appeared to prolong survival (when evaluated against historical cohorts of patients with similar baseline characteristics) versus best/palliative care in this group. This was especially true where LITT was used in brain malignancies refractory to other therapies. Twenty-four patients (average age, 40.9 years) were treated for astrocytomas (WHO I–III) and LITT was used mainly with de novo lesions in areas of inoperability/eloquence. In these tumor types, LITT appeared to be well tolerated and significantly reduced lesion size. Twenty-three patients were treated for metastatic disease (average age, 60.1 years). Equivocal benefit was found in this small cohort. All lesions treated, no matter the tumor type, in these 169 patients were ≤5 cm in diameter. Most patients underwent LITT treatment with Karnofsky index (KI) of ≥60 (where reported). Most patient","PeriodicalId":20126,"journal":{"name":"Photonics & Lasers in Medicine","volume":"13 1","pages":"77 - 93"},"PeriodicalIF":0.0,"publicationDate":"2014-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90108103","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Percutaneous selective laser amygdalo-hippocampectomy (SLAH) procedure is a new minimally invasive alternative to surgical amygdalo-hippocampectomy that involves targeted, controlled laser energy deposition under real-time magnetic resonance imaging (MRI) monitoring within a dedicated “interventional MRI” suite. Technical feasibility, safety and initial efficacy results from our program are encouraging and indicate a potential for paradigm shift in future treatment of patients with exclusively or predominantly focal unilateral seizure onsets within the mesial temporal lobe. Several institutions are currently employing this technology and more long-term follow-up results on larger cohorts of patients are expected in the near future. This article reviews the principles of MRI-guided SLAH, procedure set-up and equipment, the detailed phases of intra-procedural MRI guidance and treatment monitoring, and the MRI appearance of the resultant thermal ablation zones. We conclude with a discussion of our institutional experience at Emory University with MRI-guided SLAH as one of the leading sites offering this state-of-the-art technology.
{"title":"Percutaneous selective laser amygdalo-hippocampectomy (SLAH) for treatment of mesial temporal lobe epilepsy within an interventional MRI suite","authors":"S. Nour, J. Willie, R. Gross","doi":"10.1515/plm-2014-0003","DOIUrl":"https://doi.org/10.1515/plm-2014-0003","url":null,"abstract":"Abstract Percutaneous selective laser amygdalo-hippocampectomy (SLAH) procedure is a new minimally invasive alternative to surgical amygdalo-hippocampectomy that involves targeted, controlled laser energy deposition under real-time magnetic resonance imaging (MRI) monitoring within a dedicated “interventional MRI” suite. Technical feasibility, safety and initial efficacy results from our program are encouraging and indicate a potential for paradigm shift in future treatment of patients with exclusively or predominantly focal unilateral seizure onsets within the mesial temporal lobe. Several institutions are currently employing this technology and more long-term follow-up results on larger cohorts of patients are expected in the near future. This article reviews the principles of MRI-guided SLAH, procedure set-up and equipment, the detailed phases of intra-procedural MRI guidance and treatment monitoring, and the MRI appearance of the resultant thermal ablation zones. We conclude with a discussion of our institutional experience at Emory University with MRI-guided SLAH as one of the leading sites offering this state-of-the-art technology.","PeriodicalId":20126,"journal":{"name":"Photonics & Lasers in Medicine","volume":"15 1","pages":"117 - 128"},"PeriodicalIF":0.0,"publicationDate":"2014-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79255952","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Background: The most common type of primary brain tumors are gliomas. For patients unsuitable for open microsurgery having been treated by radiochemotherapy, laser irradiation has proven to be an alternative palliative option. From summer 1997 until winter 2006 we performed about 60 laser-interstitial thermotherapy (LITT) treatments, starting with patients with large recurrent tumors who had no other therapeutic option. In the present article we report about the neurobiological background, the technique and our experience with LITT of cerebral gliomas. Materials and method: For laser irradiation we used a specially designed light guide (LITT standard applicator; Trumpf Medizintechnik, Umkirch, Germany). The tip of this light guide is a special optical diffuser which is characterized by a homogeneous spherical or ellipsoid emission profile. The light guide was introduced into an appropriate protective sheath (Somatex, Teltow, Germany). For the laser light source, we used a continuous wave 1064-nm Nd:YAG laser (mediLas fibertom 4060 N; Dornier MedTech, Weßling, Germany). Laser irradiation was performed under general anesthesia in a 0.5 T open configuration magnetic resonance (MR) system (Signa SP; General Electric, Milwaukee, WI, USA). Usually, the tip of the light guide was positioned in the center of the tumor using the built-in localization system (Flashpoint 3000; IGT, Boulder, CO, USA) in combination, where appropriate, with a specially designed navigation system (Localite™, Bonn, Germany). The position of the light guide was then controlled using multiplanar reconstructions of T1-weighted sequences. For near real-time control, temperature monitoring was performed using an experimental software package based on the temperature-dependent shift of the MR signal. Laser irradiation was ceased when the temperature monitoring revealed a steady state temperature profile within the heated tissue. Since 2008 we have used traditional stereotactic targeting and methionine positron emission tomography/computed tomography (MET-PET/CT) instead of the ‘open’ MR system for planning and follow-up in LITT of brain tumors. Results: We started the LITT treatment of gliomas in the early 1990s (benign gliomas in eloquent regions/not suitable for surgery). In 1997 we started to treat patients with recurrent gliobastomas/anaplastic gliomas. All of these patients had an increased survival in comparison to the natural course of recurrent glioblastomas. There were no procedure-related deaths or permanent neurological deficits. Two factors seem to be important for the overall success of the LITT procedure: 1) an early enrollment in the LITT therapy after diagnosis of a tumor recurrence, and 2) a corresponding smaller tumor mass at the beginning of the therapy. Conclusion: Cytoreduction by laser irradiation seems to be a promising option for patients suffering from gliomas.
{"title":"Interstitial laser irradiation of cerebral gliomas – neurobiological background, technique and typical results","authors":"W. von Tempelhoff, F. Ulrich, H. Schwarzmaier","doi":"10.1515/plm-2014-0006","DOIUrl":"https://doi.org/10.1515/plm-2014-0006","url":null,"abstract":"Abstract Background: The most common type of primary brain tumors are gliomas. For patients unsuitable for open microsurgery having been treated by radiochemotherapy, laser irradiation has proven to be an alternative palliative option. From summer 1997 until winter 2006 we performed about 60 laser-interstitial thermotherapy (LITT) treatments, starting with patients with large recurrent tumors who had no other therapeutic option. In the present article we report about the neurobiological background, the technique and our experience with LITT of cerebral gliomas. Materials and method: For laser irradiation we used a specially designed light guide (LITT standard applicator; Trumpf Medizintechnik, Umkirch, Germany). The tip of this light guide is a special optical diffuser which is characterized by a homogeneous spherical or ellipsoid emission profile. The light guide was introduced into an appropriate protective sheath (Somatex, Teltow, Germany). For the laser light source, we used a continuous wave 1064-nm Nd:YAG laser (mediLas fibertom 4060 N; Dornier MedTech, Weßling, Germany). Laser irradiation was performed under general anesthesia in a 0.5 T open configuration magnetic resonance (MR) system (Signa SP; General Electric, Milwaukee, WI, USA). Usually, the tip of the light guide was positioned in the center of the tumor using the built-in localization system (Flashpoint 3000; IGT, Boulder, CO, USA) in combination, where appropriate, with a specially designed navigation system (Localite™, Bonn, Germany). The position of the light guide was then controlled using multiplanar reconstructions of T1-weighted sequences. For near real-time control, temperature monitoring was performed using an experimental software package based on the temperature-dependent shift of the MR signal. Laser irradiation was ceased when the temperature monitoring revealed a steady state temperature profile within the heated tissue. Since 2008 we have used traditional stereotactic targeting and methionine positron emission tomography/computed tomography (MET-PET/CT) instead of the ‘open’ MR system for planning and follow-up in LITT of brain tumors. Results: We started the LITT treatment of gliomas in the early 1990s (benign gliomas in eloquent regions/not suitable for surgery). In 1997 we started to treat patients with recurrent gliobastomas/anaplastic gliomas. All of these patients had an increased survival in comparison to the natural course of recurrent glioblastomas. There were no procedure-related deaths or permanent neurological deficits. Two factors seem to be important for the overall success of the LITT procedure: 1) an early enrollment in the LITT therapy after diagnosis of a tumor recurrence, and 2) a corresponding smaller tumor mass at the beginning of the therapy. Conclusion: Cytoreduction by laser irradiation seems to be a promising option for patients suffering from gliomas.","PeriodicalId":20126,"journal":{"name":"Photonics & Lasers in Medicine","volume":"8 1","pages":"129 - 141"},"PeriodicalIF":0.0,"publicationDate":"2014-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79500426","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Background and objective: Approximately one-third of all intracranial metastatic lesions treated with stereotactic radiosurgery (SRS) will regrow at some point during follow-up. A fraction of these lesions will require further therapy. Traditional approaches will work in a majority of, but not all, cases. Laser interstitial thermal therapy (LITT) represents a promising strategy for treatment of regrowing lesions post-SRS that are refractory to standard therapies. Materials and methods: Published literature to evaluate the role of LITT for treatment of regrowing metastatic lesions post-SRS is reviewed; own single institution experience treating these pathologies with two different commercially available LITT systems is included. Results: Early clinical studies have established that LITT can be used to successfully treat post-SRS regrowing lesions. Patients treated with LITT demonstrate both clinical and radiographic improvements following treatment, with minimal side effects. Conclusions: LITT is a promising new therapy for the management of post-SRS regrowing intracranial metastases. Large-scale clinical trials demonstrating therapeutic efficacy must be completed prior to widespread adoption of this technique.
{"title":"Laser interstitial thermal therapy for treatment of post-radiosurgery tumor recurrence and radiation necrosis","authors":"T.R. Patel, Veronica S Chiang","doi":"10.1515/plm-2013-0057","DOIUrl":"https://doi.org/10.1515/plm-2013-0057","url":null,"abstract":"Abstract Background and objective: Approximately one-third of all intracranial metastatic lesions treated with stereotactic radiosurgery (SRS) will regrow at some point during follow-up. A fraction of these lesions will require further therapy. Traditional approaches will work in a majority of, but not all, cases. Laser interstitial thermal therapy (LITT) represents a promising strategy for treatment of regrowing lesions post-SRS that are refractory to standard therapies. Materials and methods: Published literature to evaluate the role of LITT for treatment of regrowing metastatic lesions post-SRS is reviewed; own single institution experience treating these pathologies with two different commercially available LITT systems is included. Results: Early clinical studies have established that LITT can be used to successfully treat post-SRS regrowing lesions. Patients treated with LITT demonstrate both clinical and radiographic improvements following treatment, with minimal side effects. Conclusions: LITT is a promising new therapy for the management of post-SRS regrowing intracranial metastases. Large-scale clinical trials demonstrating therapeutic efficacy must be completed prior to widespread adoption of this technique.","PeriodicalId":20126,"journal":{"name":"Photonics & Lasers in Medicine","volume":"28 1","pages":"105 - 95"},"PeriodicalIF":0.0,"publicationDate":"2014-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82424687","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Missios, Jason L. Schroeder, G. Barnett, A. Mohammadi
Abstract Background: Laser interstitial thermal therapy (LITT) is a minimally invasive technique for treating intracranial tumors percutaneously. Controlled thermal damage to the tumor may offer an adjunct to the treatment of glioblastoma multiforme (GBM) especially in deep-seated locations. We report our series of patients with GBM treated with LITT. Methods: Eleven consecutive patients with GBM who underwent LITT at the Cleveland Clinic using the NeuroBlate® System were retrospectively reviewed. The extent of tumor treatment was determined using thermal-damage-threshold (TDT) lines: yellow TDT-line (reached by heating tissue to at least 43°C for 2 min) and blue TDT-line (43°C for 10 min). Volumetric analysis was performed to determine the extent of coverage of tumor volume by the TDT-lines. Kaplan-Meier curves and Cox regression analysis were used to evaluate patient outcomes. Results: LITT was delivered as upfront treatment in six cases and delivered as salvage in five cases. After 26.2 months of follow-up, 73% of cases demonstrated progression and 54.5% died. The median overall survival (OS) for the cohort was 8.4 months. Median progression free survival (PFS) was 6.1 months. A tendency towards improved overall survival was discovered in patients who had near complete coverage of tumor by blue and yellow TDT-lines. Conclusions: LITT can be used in a safe and effective manner for the treatment of patients with difficult to access GBM. Improved coverage of the tumor by the TDT-treatment lines has a tendency to improve patient overall survival.
{"title":"Prognostic factors of overall survival after laser interstitial thermal therapy in patients with glioblastoma","authors":"S. Missios, Jason L. Schroeder, G. Barnett, A. Mohammadi","doi":"10.1515/plm-2013-0051","DOIUrl":"https://doi.org/10.1515/plm-2013-0051","url":null,"abstract":"Abstract Background: Laser interstitial thermal therapy (LITT) is a minimally invasive technique for treating intracranial tumors percutaneously. Controlled thermal damage to the tumor may offer an adjunct to the treatment of glioblastoma multiforme (GBM) especially in deep-seated locations. We report our series of patients with GBM treated with LITT. Methods: Eleven consecutive patients with GBM who underwent LITT at the Cleveland Clinic using the NeuroBlate® System were retrospectively reviewed. The extent of tumor treatment was determined using thermal-damage-threshold (TDT) lines: yellow TDT-line (reached by heating tissue to at least 43°C for 2 min) and blue TDT-line (43°C for 10 min). Volumetric analysis was performed to determine the extent of coverage of tumor volume by the TDT-lines. Kaplan-Meier curves and Cox regression analysis were used to evaluate patient outcomes. Results: LITT was delivered as upfront treatment in six cases and delivered as salvage in five cases. After 26.2 months of follow-up, 73% of cases demonstrated progression and 54.5% died. The median overall survival (OS) for the cohort was 8.4 months. Median progression free survival (PFS) was 6.1 months. A tendency towards improved overall survival was discovered in patients who had near complete coverage of tumor by blue and yellow TDT-lines. Conclusions: LITT can be used in a safe and effective manner for the treatment of patients with difficult to access GBM. Improved coverage of the tumor by the TDT-treatment lines has a tendency to improve patient overall survival.","PeriodicalId":20126,"journal":{"name":"Photonics & Lasers in Medicine","volume":"1 1","pages":"143 - 150"},"PeriodicalIF":0.0,"publicationDate":"2014-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82900922","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Loshchenov, P. Zelenkov, A. Potapov, S. Goryajnov, A. Borodkin
Abstract Background: Fluorescence endoscopy systems for photosensitizer visualization have proved to be powerful tools for highlighting malignant tumor boundaries as well as detecting small, visually non-detectable, residual parts during photodynamic therapy. Most of these devices use excitation wavelengths in the blue visual spectrum range (405 nm) which limits the penetration depth in the tissue. Objective: In the study being presented in this article an apparatus and a method were developed for performing endoscopic fluorescence diagnostics of photosensitizer accumulation using excitation light in the red part of visual spectrum, i.e., 635 nm, which allows not only a deeper penetration of light into the tissue but also better scanning abilities and a higher diagnostic quality. Additionally, 635-nm radiation can penetrate thin layers of blood which appear during surgery. Material and methods: In order to use 635-nm excitation, a specially designed video endoscopy system was developed. The key feature of the video system is a dual camera video receiver where one sensitive B/W camera receives the fluorescence signal and a color camera receives the real-time image in natural colors during navigation. The software developed for the apparatus allows overlaying of the video output of fluorescence image on top of the conventional color image in real-time. The experimental setup and method were tested on Intralipid-based phantoms with protoporphyrin IX (PpIX) concentrations of 0.5–5 mg/kg, and then on two patients during surgery. The patients were administered 20 mg/kg 5-ALA photosensitizer 3 h before surgery according to standard practice of 5-ALA in neurosurgery. Results: The experiments demonstrate that the designed setup is sensitive enough for clear visualization of biological concentrations of PpIX in both phantoms with 0.5 mg/kg PpIX and previously photosensitized tissues of patients. Conclusion: Further prospective validation is needed to translate the results to clinical practice.
{"title":"Endoscopic fluorescence visualization of 5-ALA photosensitized central nervous system tumors in the neural tissue transparency spectral range","authors":"M. Loshchenov, P. Zelenkov, A. Potapov, S. Goryajnov, A. Borodkin","doi":"10.1515/plm-2013-0017","DOIUrl":"https://doi.org/10.1515/plm-2013-0017","url":null,"abstract":"Abstract Background: Fluorescence endoscopy systems for photosensitizer visualization have proved to be powerful tools for highlighting malignant tumor boundaries as well as detecting small, visually non-detectable, residual parts during photodynamic therapy. Most of these devices use excitation wavelengths in the blue visual spectrum range (405 nm) which limits the penetration depth in the tissue. Objective: In the study being presented in this article an apparatus and a method were developed for performing endoscopic fluorescence diagnostics of photosensitizer accumulation using excitation light in the red part of visual spectrum, i.e., 635 nm, which allows not only a deeper penetration of light into the tissue but also better scanning abilities and a higher diagnostic quality. Additionally, 635-nm radiation can penetrate thin layers of blood which appear during surgery. Material and methods: In order to use 635-nm excitation, a specially designed video endoscopy system was developed. The key feature of the video system is a dual camera video receiver where one sensitive B/W camera receives the fluorescence signal and a color camera receives the real-time image in natural colors during navigation. The software developed for the apparatus allows overlaying of the video output of fluorescence image on top of the conventional color image in real-time. The experimental setup and method were tested on Intralipid-based phantoms with protoporphyrin IX (PpIX) concentrations of 0.5–5 mg/kg, and then on two patients during surgery. The patients were administered 20 mg/kg 5-ALA photosensitizer 3 h before surgery according to standard practice of 5-ALA in neurosurgery. Results: The experiments demonstrate that the designed setup is sensitive enough for clear visualization of biological concentrations of PpIX in both phantoms with 0.5 mg/kg PpIX and previously photosensitized tissues of patients. Conclusion: Further prospective validation is needed to translate the results to clinical practice.","PeriodicalId":20126,"journal":{"name":"Photonics & Lasers in Medicine","volume":"13 1","pages":"159 - 170"},"PeriodicalIF":0.0,"publicationDate":"2014-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86763696","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jason L. Schroeder, S. Missios, G. Barnett, A. Mohammadi
Abstract Introduction: Deep-seated hemispheric brain tumors pose unique challenges for surgical treatment. These tumors are often considered inoperable and when surgery is undertaken significant, serious, morbidity and even mortality may complicate the outcome. Laser interstitial thermal therapy (LITT) is a minimally invasive alternative to traditional open surgery that affects tumor cell death by producing a zone of thermal tissue damage that can be monitored and controlled with the aid of real-time magnetic resonance thermography. Subjects and methods: A retrospective review of six patients treated with LITT at the Cleveland Clinic between 5/2011 and 8/2013 was performed. We evaluated clinical patient data and pre-, intra-, and post-operative magnetic resonance imaging (MRI) data for correlation. Results: Six patients were treated with a total of eight separate LITT procedures for their thalamic (n=5) or basal ganglia (n=1) tumors. All tumors were histologically malignant and five were primary tumors. Pre- and post-operative neurological deficits were recorded. The two patients that underwent multiple procedures were retreated for different reasons – one due to insufficient coverage and the other due to tumor recurrence. Sustained post-operative neurological deficits were observed after three procedures and one patient died within 2 days of surgery from a thalamic hemorrhage. Conclusions: LITT is a minimally invasive surgical treatment that can lead to successful ablation of tumors of the thalamus or basal ganglia. However, this treatment has the potential for neurological morbidity or even mortality and as such further studies are needed to evaluate the true risk vs. reward potential for LITT with regard to treating deep-seated tumors.
{"title":"Laser interstitial thermal therapy as a novel treatment modality for brain tumors in the thalamus and basal ganglia","authors":"Jason L. Schroeder, S. Missios, G. Barnett, A. Mohammadi","doi":"10.1515/plm-2013-0053","DOIUrl":"https://doi.org/10.1515/plm-2013-0053","url":null,"abstract":"Abstract Introduction: Deep-seated hemispheric brain tumors pose unique challenges for surgical treatment. These tumors are often considered inoperable and when surgery is undertaken significant, serious, morbidity and even mortality may complicate the outcome. Laser interstitial thermal therapy (LITT) is a minimally invasive alternative to traditional open surgery that affects tumor cell death by producing a zone of thermal tissue damage that can be monitored and controlled with the aid of real-time magnetic resonance thermography. Subjects and methods: A retrospective review of six patients treated with LITT at the Cleveland Clinic between 5/2011 and 8/2013 was performed. We evaluated clinical patient data and pre-, intra-, and post-operative magnetic resonance imaging (MRI) data for correlation. Results: Six patients were treated with a total of eight separate LITT procedures for their thalamic (n=5) or basal ganglia (n=1) tumors. All tumors were histologically malignant and five were primary tumors. Pre- and post-operative neurological deficits were recorded. The two patients that underwent multiple procedures were retreated for different reasons – one due to insufficient coverage and the other due to tumor recurrence. Sustained post-operative neurological deficits were observed after three procedures and one patient died within 2 days of surgery from a thalamic hemorrhage. Conclusions: LITT is a minimally invasive surgical treatment that can lead to successful ablation of tumors of the thalamus or basal ganglia. However, this treatment has the potential for neurological morbidity or even mortality and as such further studies are needed to evaluate the true risk vs. reward potential for LITT with regard to treating deep-seated tumors.","PeriodicalId":20126,"journal":{"name":"Photonics & Lasers in Medicine","volume":"13 1","pages":"151 - 158"},"PeriodicalIF":0.0,"publicationDate":"2014-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74898613","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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