Magnetic resonance–guided stereotactic laser ablation therapy for the treatment of pediatric brain tumors: a multiinstitutional retrospective study

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  • 1 Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin;
  • 2 Department of Neurosurgery, Children’s Hospital of Wisconsin, Milwaukee, Wisconsin;
  • 3 Department of Neurosurgery, Children’s Hospital Colorado, Aurora, Colorado;
  • 4 Department of Neurosurgery, SUNY Upstate Medical University, Syracuse, New York;
  • 5 Department of Neurosurgery, St. Louis Children’s Hospital, St. Louis, Missouri;
  • 6 Department of Neurosurgery, Primary Children’s Hospital, Salt Lake City, Utah;
  • 7 Departments of Neurosurgery and
  • 8 Neurology, Cook Children’s Hospital, Fort Worth, Texas;
  • 9 Department of Neurosurgery, Rady Children’s Hospital-San Diego, California;
  • 10 Department of Neurosurgery, Cincinnati Children’s Hospital, Cincinnati, Ohio;
  • 11 Department of Neurosurgery, Children’s Hospital of Philadelphia, Pennsylvania;
  • 12 Department of Neurosurgery, University of Texas Southwestern Medical Center, Dallas, Texas;
  • 13 Department of Neurosurgery, Wake Forest Baptist Health, Winston-Salem, North Carolina;
  • 14 Department of Neurosurgery, Children’s National Health System, Washington, DC;
  • 15 Department of Neurosurgery, Massachusetts General Hospital for Children, Boston, Massachusetts;
  • 16 Department of Neurosurgery, Cleveland Clinic Children’s, Cleveland, Ohio;
  • 17 Department of Neurosurgery, Duke Children’s Hospital, Durham, North Carolina;
  • 18 Department of Neurosurgery, Penn State Health, Hershey, Pennsylvania;
  • 19 Department of Neurosurgery, UCLA Mattel Children’s Hospital, Los Angeles, California;
  • 20 Department of Neurosurgery, Nicklaus Children’s Hospital, Miami, Florida; and
  • 21 Department of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin
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OBJECTIVE

This study aimed to assess the safety and efficacy of MR-guided stereotactic laser ablation (SLA) therapy in the treatment of pediatric brain tumors.

METHODS

Data from 17 North American centers were retrospectively reviewed. Clinical, technical, and radiographic data for pediatric patients treated with SLA for a diagnosis of brain tumor from 2008 to 2016 were collected and analyzed.

RESULTS

A total of 86 patients (mean age 12.2 ± 4.5 years) with 76 low-grade (I or II) and 10 high-grade (III or IV) tumors were included. Tumor location included lobar (38.4%), deep (45.3%), and cerebellar (16.3%) compartments. The mean follow-up time was 24 months (median 18 months, range 3–72 months). At the last follow-up, the volume of SLA-treated tumors had decreased in 80.6% of patients with follow-up data. Patients with high-grade tumors were more likely to have an unchanged or larger tumor size after SLA treatment than those with low-grade tumors (OR 7.49, p = 0.0364). Subsequent surgery and adjuvant treatment were not required after SLA treatment in 90.4% and 86.7% of patients, respectively. Patients with high-grade tumors were more likely to receive subsequent surgery (OR 2.25, p = 0.4957) and adjuvant treatment (OR 3.77, p = 0.1711) after SLA therapy, without reaching significance. A total of 29 acute complications in 23 patients were reported and included malpositioned catheters (n = 3), intracranial hemorrhages (n = 2), transient neurological deficits (n = 11), permanent neurological deficits (n = 5), symptomatic perilesional edema (n = 2), hydrocephalus (n = 4), and death (n = 2). On long-term follow-up, 3 patients were reported to have worsened neuropsychological test results. Pre-SLA tumor volume, tumor location, number of laser trajectories, and number of lesions created did not result in a significantly increased risk of complications; however, the odds of complications increased by 14% (OR 1.14, p = 0.0159) with every 1-cm3 increase in the volume of the lesion created.

CONCLUSIONS

SLA is an effective, minimally invasive treatment option for pediatric brain tumors, although it is not without risks. Limiting the volume of the generated thermal lesion may help decrease the incidence of complications.

ABBREVIATIONS HGG = high-grade glioma; ICH = intracranial hemorrhage; SLA = stereotactic laser ablation; TOI = target of interest.

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Contributor Notes

Correspondence Sean M. Lew: Medical College of Wisconsin, Children’s Hospital of Wisconsin, Milwaukee, WI. slew@mcw.edu.

INCLUDE WHEN CITING Published online March 27, 2020; DOI: 10.3171/2020.1.PEDS19496.

Disclosures Dr. Tovar-Spinoza: consultant for Monteris Inc. Dr. Perry: consultant for Encoded Therapeutics and Stoke Therapeutics, and honoraria for advisory board/speaking from Biocodex and Zogenix. Dr. Barnett: consultant for Monteris Medical Inc.

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