Brain: Interstitial Laser Therapy (ILT)

[Ivan]

Discuss ILT here.

[Olga]

It is a treatment when the probe is inserted through the skull and the brain met is cooked by the high temperature. It can be uaed when the location of the met is not accessible for the surgery.
We have a patient here on the board who had this treatment.
Done by the neurosurgeon Peter M. Black,
http://www.boston-neurosurg.org/faculty/black.html.

I found that they say
"We are currently treating brain tumors with interstitial laser therapy"

on this page
http://www.brighamandwomens.org/radiolo ... erapy.aspx
this treatment has a very low long term toxicity and they can test if the tumor is necrotic right after the procedure using the same probe.

[Olga]

New article about the advances in the use of this laser technology for the metastatic brain tumors treatment (the authors call it Laser thermal therapy):
Laser thermal therapy: Real-time MRI-guided and computer-controlled procedures for metastatic brain tumors
Lasers in Surgery and Medicine
Volume 43, Issue 10, pages 943–950, December 2011
http://onlinelibrary.wiley.com/doi/10.1 ... 8/abstract

They report the final results of a pilot clinical trial exploring the safety and feasibility of real-time magnetic resonance-guided laser-induced thermal therapy (MRgLITT) for treatment of resistant focal metastatic intracranial tumors.
Conclusion
Real-time magnetic resonance (MR) guidance of laser-induced thermal therapy (LITT) offers a high level of control. This tool therefore enables a minimally invasive option for destruction and treatment of resistant focal metastatic intracranial tumors. MR-guided LITT appears to provide a safe and potentially effective treatment for recurrent focal metastatic brain disease. A larger phase II and III series would be of interest to quantify potential median survival advantage.

My commentary:
The study described in this article is taking place in France although the company developing the device is Biotex Inc. Houston, Texas and they work with the Department of Imaging Physics, University of Texas M.D. Anderson Cancer Center, Houston, Texas so the trial might be open (or will be open) there as well.
There is an advantage for this treatment versus radiosurgery that is the most often used treatment modality for this type of the brain mets (small, single digits) - there is less radiation damage to the surrounding tissue and it is very important for young ASPS patients with their typically slow growing disease.

[Feng zhou]

Olga,
laser-induced thermal therapy,There have been four clinical trials, three of them in the recruitment of patients.
1,Magnetic Resonance Temperature Imaging & Imaging-Guided Laser Induced Thermal Therapy for Treatment of Metastatic Brain Tumors.
http://clinicaltrials.gov/ct2/show/NCT0 ... apy&rank=2
2,Correlation of MR Thermal Imaging to Actual Size of Ablation During Laser Ablation Therapy Conditions: Advanced Cancer; Bone Metastases
http://clinicaltrials.gov/ct2/show/NCT0 ... apy&rank=4
3,Laser Based Focal Ablation of Low Grade Prostate Cancer Condition: Low Grade Prostate Cancer

[Olga]

The technology unit to perform Laser Interstitial Thermal Therapy in a brain (called Monteris® Medical’s AutoLITT (old name)- NeuroBlate (new name) system) receives regulatory approval in US and Canada now. It seems that it has some advantage versus radiosurgery as the doc is able to see if the tumor is completely dead right during the procedure versus waiting for the next MRI scan in a few months after the radiosurgery to verify that the target was not missed.
Some technical info:
The system allows for controlled, 3-dimensional ablation of lesions, as well as providing post-procedure confirmation of the effects of the thermal therapy using MRI. It is the successor to the company’s AutoLITT system, which was released several years ago.

The NeuroBlate probe is a small, CO2-cooled side-firing fiber optic probe which can be used in conjunction with a standard 1.5 Tesla MRI system. The software provides MRI-based trajectory planning assistance for the stereotaxic placement of the probe, which is positioned through a transcranial burr hole, directly at the location of the tumor. The laser is then used to laterally heat up and burn away tumor tissue while cooling the environment on the opposite side of the laser’s direction, thereby preventing surrounding tissue from being damaged. Laser bursts last from 30 seconds up to several minutes, and heat up tissue to about 160 degrees Fahrenheit (70 degrees Celsius). Using MR thermography, the MRI data is used to monitor the temperature for real-time monitoring of the procedure and visualization of the results.

The practical question for our community is to find a place that has more experience with it. I found that prior to this approval, it was already avail. in British Columbia, Canada, under a “special access waiver” granted for patients of Dr. Brian Toyota, M.D., in Vancouver (we will try to find out if they use it extensively).
The clinical trial leading to FDA approval was done at the Cleveland Clinic and University Hospitals at Case Western Medical Center in Cleveland, so I would expect them to have at least some experience with it. There is a referral service at the Monteris web-site that allows to find a physician performing that in your region:
http://www.monteris.com/minimally-invasive-neurosurgery

[Bonni Hess]

Dear Olga,
Thank you for sharing this important updated information. ILT is the then very new and cutting edge procedure that Brittany underwent at Bringham and Women's Hospital in Boston eight years ago this July for suspected reoccurrence of her resected brain mets after a PET scan at the University of Washington in Seattle had erroneously shown possible tumor bed reoccurence (we now know that PET scans can be unreliable and inaccurate). Thankfully the neurosurgeon Dr. Peter Black found no brain tumor reoccurrence so there was no tumor tissue to remove. It was unnecessary for Brittany to have had to undergo this procedure, but had tumor reoccurrence been found, it would have been an invaluable and minimally invasive treatment option for a dangerously located/unresectable tumor.
Is ILT a procedure which you are considering for Ivan's recently diagnosed suspected brain met? I will be anxiously awaiting your or Ivan's update regarding what treatment decision has been made, and if ILT is the treatment that Ivan will undergo to shrink/destroy/remove the nodule as opposed to Gamma Knife, Cyberknife, or resection.
Take care Olga and know that my most special thoughts and very best wishes are with Ivan, you, and your family.
With deepest caring, healing wishes for Ivan, and continued Hope,
Bonni

[Olga]

Bonni, thank you for the best wishes.
We do not know anything yet - if this is a met, what they can/willing to do to verify that, where it is located and what treatment are avail. locally and how soon, so I am just researching the subject to keep myself busy while waiting.

[Bonni Hess]

Hello again dear Olga,
Thank you for your thoughtful response. Researching treatment options is definitely a very good and positive way to focus your energy and occupy your mind during the stressful waiting for more information from the neurosurgeon. Please let me know if I can help in any way with shared information from our brain met experience with Brittany.
Reaching out across the miles with special hugs, caring thoughts, healing wishes for Ivan, and continued Hope,
Bonni