Malignant cerebral edema associated with radiation and laser ablation for brain tumors

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Conference Proceeding

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Objective: Our aim was to investigate whether laser interstitial thermal therapy (LITT) and radiotherapy (RT) in close succession to each other induced worsening symptomatic cerebral edema. Background: LITT is an image-guided technique that uses high temperatures to ablate pathological tissue and is commonly used for recurrent or deeply seated tumors. Some patients are also treated with adjuvant RT. Design/Methods: We retrospectively reviewed records of patients who underwent Visualase LITT at our institution (March 2014-February 2016) and RT less than 60 days apart. Magnetic resonance imaging (MRI) brain and clinical information were reviewed at three time points (pre-treatment, post-LITT, and post-RT). Data is presented as a median (range). Results: We studied 10 patients with brain tumor; 8 glioblastoma, 1 anaplastic astrocytoma, and 1 metastasis, 6 (60%) were men, age at treatment was 61.5 (52-76) years. There were 6 cortical versus 4 subcortical tumors. The majority of patients underwent LITT followed by RT except for 2. Time interval between LITT and RT was 24 (9-43) days. Increased ablation volume post-LITT compared to pre-operatively tumor volume was seen in 9 patients with a mean enlargement of 15% overall. RT treatments included external beam fractionated radiation treatment (EBRT) (n=8), EBRT with stereotactic radiosurgery (SRS) (n=1), and fractionated SRS (n=1). Pre-treatment MRI showed cerebral edema in 9 patients. Post-LITT MRI showed worsening cerebral edema in 4 patients, 3 were symptomatic (1 had disease progression). One patient who received RT prior to LITT had asymptomatic cerebral edema post-RT that improved post-LITT. Post-RT MRI showed worsening symptomatic cerebral edema in a patient who had EBRT+SRS. Avastin was used in 1 patient and 2 patients had prolonged use of steroids (>65 days). Conclusions: LITT and RT treatment can induce symptomatic cerebral edema which can be effectively managed with steroids and/or Avastin. Treating physicians need to be cognizant of this risk.




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