Alireza M Mohammadi1, Mayur Sharma1, Thomas L Beaumont2, Kevin O Juarez3, Hanna Kemeny4, Cosette Dechant4, Andreas Seas4, Nehaw Sarmey1, Bryan S Lee1, Xuefei Jia5, Peter E Fecci4, Joachim Baehring3, Jennifer Moliterno3, Veronica L Chiang3, Manmeet S Ahluwalia1, Albert H Kim2, Gene H Barnett1, Eric C Leuthardt2,6,7. 1. The Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Department of Neurosurgery, Neurological Institute, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio. 2. Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri. 3. Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut. 4. Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina. 5. Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio. 6. Department of Biomedical Engineering, Center for Innovation in Neuroscience and Technology, Washington University School of Medicine, St. Louis, Missouri. 7. Department of Mechanical Engineering and Material Science, Center for Innovation in Neuroscience and Technology, Washington University, School of Medicine, St. Louis, Missouri.
Abstract
BACKGROUND: Laser ablation (LA) is used as an upfront treatment in patients with deep seated newly diagnosed Glioblastoma (nGBM). OBJECTIVE: To evaluate the outcomes of LA in patients with nGBM and compare them with a matched biopsy-only cohort. METHODS: Twenty-four nGBM patients underwent upfront LA at Cleveland clinic, Washington University in St. Louis, and Yale University (6/2011-12/2014) followed by chemo/radiotherapy. Also, 24 out of 171 nGBM patients with biopsy followed by chemo/radiotherapy were matched based on age (< 70 vs ≥ 70), gender, tumor location (deep vs lobar), and volume (<11 cc vs ≥11 cc). Progression-free survival (PFS), overall survival (OS), and disease-specific PFS and OS were outcome measures. Three prognostic groups were identified based on extent of tumor ablation by thermal-damage-threshold (TDT)-lines. RESULTS: The median tumor volume in LA (n = 24) and biopsy only (n = 24) groups was 9.3 cm3 and 8.2 cm3 respectively. Overall, median estimate of OS and PFS in LA cohort was 14.4 and 4.3 mo compared to 15.8 mo and 5.9 mo for biopsy only cohort. On multivariate analysis, favorable TDT-line prognostic groups were associated with lower incidence of disease specific death (P = .03) and progression (P = .05) compared to other groups including biopsy only cohort. Only age (<70 yr, P = .02) and tumor volume (<11 cc, P = .03) were favorable prognostic factors for OS. CONCLUSION: The maximum tumor coverage by LA followed by radiation/chemotherapy is an effective treatment modality in patients with nGBM, compared to biopsy only cohort. The TDT-line prognostic groups were independent predictor of disease specific death and progression after LA.
BACKGROUND: Laser ablation (LA) is used as an upfront treatment in patients with deep seated newly diagnosed Glioblastoma (nGBM). OBJECTIVE: To evaluate the outcomes of LA in patients with nGBM and compare them with a matched biopsy-only cohort. METHODS: Twenty-four nGBM patients underwent upfront LA at Cleveland clinic, Washington University in St. Louis, and Yale University (6/2011-12/2014) followed by chemo/radiotherapy. Also, 24 out of 171 nGBM patients with biopsy followed by chemo/radiotherapy were matched based on age (< 70 vs ≥ 70), gender, tumor location (deep vs lobar), and volume (<11 cc vs ≥11 cc). Progression-free survival (PFS), overall survival (OS), and disease-specific PFS and OS were outcome measures. Three prognostic groups were identified based on extent of tumor ablation by thermal-damage-threshold (TDT)-lines. RESULTS: The median tumor volume in LA (n = 24) and biopsy only (n = 24) groups was 9.3 cm3 and 8.2 cm3 respectively. Overall, median estimate of OS and PFS in LA cohort was 14.4 and 4.3 mo compared to 15.8 mo and 5.9 mo for biopsy only cohort. On multivariate analysis, favorable TDT-line prognostic groups were associated with lower incidence of disease specific death (P = .03) and progression (P = .05) compared to other groups including biopsy only cohort. Only age (<70 yr, P = .02) and tumor volume (<11 cc, P = .03) were favorable prognostic factors for OS. CONCLUSION: The maximum tumor coverage by LA followed by radiation/chemotherapy is an effective treatment modality in patients with nGBM, compared to biopsy only cohort. The TDT-line prognostic groups were independent predictor of disease specific death and progression after LA.
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Authors: Albert H Kim; Steven Tatter; Ganesh Rao; Sujit Prabhu; Clark Chen; Peter Fecci; Veronica Chiang; Kris Smith; Brian J Williams; Alireza M Mohammadi; Kevin Judy; Andrew Sloan; Zulma Tovar-Spinoza; James Baumgartner; Constantinos Hadjipanayis; Eric C Leuthardt Journal: Neurosurgery Date: 2020-09-01 Impact factor: 4.654
Authors: Elsa V Arocho-Quinones; Sean M Lew; Michael H Handler; Zulma Tovar-Spinoza; Matthew Smyth; Robert Bollo; David Donahue; M Scott Perry; Michael L Levy; David Gonda; Francesco T Mangano; Phillip B Storm; Angela V Price; Daniel E Couture; Chima Oluigbo; Ann-Christine Duhaime; Gene H Barnett; Carrie R Muh; Michael D Sather; Aria Fallah; Anthony C Wang; Sanjiv Bhatia; Kadam Patel; Sergey Tarima; Sarah Graber; Sean Huckins; Daniel M Hafez; Kavelin Rumalla; Laurie Bailey; Sabrina Shandley; Ashton Roach; Erin Alexander; Wendy Jenkins; Deki Tsering; George Price; Antonio Meola; Wendi Evanoff; Eric M Thompson; Nicholas Brandmeir Journal: J Neurosurg Pediatr Date: 2020-03-27 Impact factor: 2.375