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Laser interstitial thermal therapy (LITT) vs. bevacizumab for radiation necrosis in previously irradiated brain metastases.
J Neurooncol. 2020 Jun 29 [Online ahead of print]JN

Abstract

PURPOSE

Both laser interstitial thermal therapy (LITT) and bevacizumab have been used successfully to treat radiation necrosis (RN) after radiation for brain metastases. Our purpose is to compare pre-treatment patient characteristics and outcomes between the two treatment options.

METHODS

Single-institution retrospective chart review identified brain metastasis patients who developed RN between 2011 and 2018. Pre-treatment factors and treatment responses were compared between those treated with LITT versus bevacizumab.

RESULTS

Twenty-five patients underwent LITT and 13 patients were treated with bevacizumab. The LITT cohort had a longer overall survival (median 24.8 vs. 15.2 months for bevacizumab, p = 0.003) and trended to have a longer time to local recurrence (median 12.1 months vs. 2.0 for bevacizumab), although the latter failed to achieve statistical significance (p = 0.091). LITT resulted in an initial increase in lesional volume compared to bevacizumab (p < 0.001). However, this trend reversed in the long term follow-up, with LITT resulting in a median volume decrease at 1 year post-treatment of - 64.7% (range - 96.0% to + > 100%), while bevacizumab patients saw a median volume increase of + > 100% (range - 63.0% to + > 100%), p = 0.010.

CONCLUSIONS

Our study suggests that patients undergoing LITT for RN have longer overall survival and better long-term lesional volume reduction than those treated with bevacizumab. However, it remains unclear whether our findings are due only to a difference in efficacy of the treatments or the implications of selection bias.

Authors+Show Affiliations

Department of Neurosurgery, Yale University School of Medicine, 333 Cedar St, New Haven, CT, 06520, USA.Department of Neurosurgery, Yale University School of Medicine, 333 Cedar St, New Haven, CT, 06520, USA.Department of Pharmacy Services, Yale-New Haven Hospital, 20 York St, New Haven, CT, 06510, USA.Department of Neurosurgery, Yale University School of Medicine, 333 Cedar St, New Haven, CT, 06520, USA.Department of Neurosurgery, Yale University School of Medicine, 333 Cedar St, New Haven, CT, 06520, USA.Department of Neurosurgery, Yale University School of Medicine, 333 Cedar St, New Haven, CT, 06520, USA.Department of Neurology, Yale University School of Medicine, 333 Cedar St, New Haven, CT, 06520, USA.Department of Neurosurgery, Yale University School of Medicine, 333 Cedar St, New Haven, CT, 06520, USA. veronica.chiang@yale.edu.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32602021

Citation

Sujijantarat, Nanthiya, et al. "Laser Interstitial Thermal Therapy (LITT) Vs. Bevacizumab for Radiation Necrosis in Previously Irradiated Brain Metastases." Journal of Neuro-oncology, 2020.
Sujijantarat N, Hong CS, Owusu KA, et al. Laser interstitial thermal therapy (LITT) vs. bevacizumab for radiation necrosis in previously irradiated brain metastases. J Neurooncol. 2020.
Sujijantarat, N., Hong, C. S., Owusu, K. A., Elsamadicy, A. A., Antonios, J. P., Koo, A. B., Baehring, J. M., & Chiang, V. L. (2020). Laser interstitial thermal therapy (LITT) vs. bevacizumab for radiation necrosis in previously irradiated brain metastases. Journal of Neuro-oncology. https://doi.org/10.1007/s11060-020-03570-0
Sujijantarat N, et al. Laser Interstitial Thermal Therapy (LITT) Vs. Bevacizumab for Radiation Necrosis in Previously Irradiated Brain Metastases. J Neurooncol. 2020 Jun 29; PubMed PMID: 32602021.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Laser interstitial thermal therapy (LITT) vs. bevacizumab for radiation necrosis in previously irradiated brain metastases. AU - Sujijantarat,Nanthiya, AU - Hong,Christopher S, AU - Owusu,Kent A, AU - Elsamadicy,Aladine A, AU - Antonios,Joseph P, AU - Koo,Andrew B, AU - Baehring,Joachim M, AU - Chiang,Veronica L, Y1 - 2020/06/29/ PY - 2020/05/16/received PY - 2020/06/23/accepted PY - 2020/7/1/entrez KW - Bevacizumab KW - Brain metastasis KW - Laser ablation KW - Radiation necrosis JF - Journal of neuro-oncology JO - J. Neurooncol. N2 - PURPOSE: Both laser interstitial thermal therapy (LITT) and bevacizumab have been used successfully to treat radiation necrosis (RN) after radiation for brain metastases. Our purpose is to compare pre-treatment patient characteristics and outcomes between the two treatment options. METHODS: Single-institution retrospective chart review identified brain metastasis patients who developed RN between 2011 and 2018. Pre-treatment factors and treatment responses were compared between those treated with LITT versus bevacizumab. RESULTS: Twenty-five patients underwent LITT and 13 patients were treated with bevacizumab. The LITT cohort had a longer overall survival (median 24.8 vs. 15.2 months for bevacizumab, p = 0.003) and trended to have a longer time to local recurrence (median 12.1 months vs. 2.0 for bevacizumab), although the latter failed to achieve statistical significance (p = 0.091). LITT resulted in an initial increase in lesional volume compared to bevacizumab (p < 0.001). However, this trend reversed in the long term follow-up, with LITT resulting in a median volume decrease at 1 year post-treatment of - 64.7% (range - 96.0% to + > 100%), while bevacizumab patients saw a median volume increase of + > 100% (range - 63.0% to + > 100%), p = 0.010. CONCLUSIONS: Our study suggests that patients undergoing LITT for RN have longer overall survival and better long-term lesional volume reduction than those treated with bevacizumab. However, it remains unclear whether our findings are due only to a difference in efficacy of the treatments or the implications of selection bias. SN - 1573-7373 UR - https://www.unboundmedicine.com/medline/citation/32602021/Laser_interstitial_thermal_therapy_(LITT)_vs._bevacizumab_for_radiation_necrosis_in_previously_irradiated_brain_metastases L2 - https://doi.org/10.1007/s11060-020-03570-0 DB - PRIME DP - Unbound Medicine ER -
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