TY - JOUR
T1 - Magnetic resonance–guided stereotactic laser ablation therapy for the treatment of pediatric brain tumors
T2 - a multiinstitutional retrospective study
AU - the Pediatric Stereotactic Laser Ablation Workgroup
AU - Arocho-Quinones, Elsa V.
AU - Lew, Sean M.
AU - Handler, Michael H.
AU - Tovar-Spinoza, Zulma
AU - Smyth, Matthew
AU - Bollo, Robert
AU - Donahue, David
AU - Scott Perry, M.
AU - Levy, Michael L.
AU - Gonda, David
AU - Mangano, Francesco T.
AU - Storm, Phillip B.
AU - Price, Angela V.
AU - Couture, Daniel E.
AU - Oluigbo, Chima
AU - Duhaime, Ann Christine
AU - Barnett, Gene H.
AU - Muh, Carrie R.
AU - Sather, Michael D.
AU - Fallah, Aria
AU - Wang, Anthony C.
AU - Bhatia, Sanjiv
AU - Patel, Kadam
AU - Tarima, Sergey
AU - Graber, Sarah
AU - Huckins, Sean
AU - Hafez, Daniel M.
AU - Rumalla, Kavelin
AU - Bailey, Laurie
AU - Shandley, Sabrina
AU - Roach, Ashton
AU - Alexander, Erin
AU - Jenkins, Wendy
AU - Tsering, Deki
AU - Price, George
AU - Meola, Antonio
AU - Evanoff, Wendi
AU - Thompson, Eric M.
AU - Brandmeir, Nicholas
N1 - Publisher Copyright:
©AANS 2020
PY - 2020/7
Y1 - 2020/7
N2 - 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 neuro-psychological 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.
AB - 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 neuro-psychological 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.
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U2 - 10.3171/2020.1.PEDS19496
DO - 10.3171/2020.1.PEDS19496
M3 - Article
C2 - 32217793
AN - SCOPUS:85087970947
SN - 1933-0707
VL - 26
SP - 13
EP - 21
JO - Journal of Neurosurgery: Pediatrics
JF - Journal of Neurosurgery: Pediatrics
IS - 1
ER -