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Histological changes associated with laser interstitial thermal therapy for radiation necrosis: illustrative cases
Journal article   Open access

Histological changes associated with laser interstitial thermal therapy for radiation necrosis: illustrative cases

Elena I Fomchenko, Nalin Leelatian, Armine Darbinyan, Anita J Huttner and Veronica L Chiang
Journal of neurosurgery. Case lessons, v 4(1), pCASE21373
04 Jul 2022
DOI: https://doi.org/10.3171/CASE21373
PMID: 35855352
url
https://doi.org/10.3171/CASE21373View
Published, Version of Record (VoR) Open

Abstract

laser interstitial thermal therapy LITT = laser interstitial thermal therapy anti-PD1 = anti-programmed cell death 1 NSCLC = non-small cell lung cancer anti-CTLA4 = anti-cytotoxic T-lymphocyte-associated protein 4 histological change PD-L1 = programmed cell death ligand 1 radiation necrosis SRS = stereotactic radiosurgery RN = radiation necrosis MRI = magnetic resonance imaging
Patients with lung cancer and melanoma remain the two largest groups to develop brain metastases. Immunotherapy has been approved for treatment of stage IV disease in both groups. Many of these patients are additionally treated with stereotactic radiosurgery for their brain metastases during ongoing immunotherapy. Use of immunotherapy has been reported to increase the rates of radiation necrosis (RN) after radiosurgery, causing neurological compromise due to growth of the enhancing lesion as well as worsening of associated cerebral edema. Laser interstitial thermal therapy (LITT) is a surgical approach that has been shown effective in the management of RN, especially given its efficacy in early reduction of perilesional edema. However, little remains known about the pathology of the post-LITT lesions and how LITT works in this condition. Here, we present two patients who needed surgical decompression after LITT for RN. Clinical, histopathological, and imaging features of both patients are presented. Criteria for selecting the best patients with RN for LITT therapy remains unclear. Given two similarly sized lesions and not too dissimilar clinical histories but with differing outcomes, further investigation is clearly needed to identify predictors of response to LITT in the setting of SRS and immunotherapy-induced RN.

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