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14. DELAYED MRI RESPONSE TO LITT IN PATIENTS UNDERGOING IMMUNOTHERAPY

Laser interstitial thermal therapy (LITT) is an effective treatment for regrowing lesions after previous radiosurgery to brain metastases, typically resulting in decreased perilesional edema within weeks followed by delayed reduction in lesion size. We have anecdotally observed that patients on immu...

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Autores principales: Hong, Christopher, Chiang, Veronica
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7401361/
http://dx.doi.org/10.1093/noajnl/vdaa073.006
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author Hong, Christopher
Chiang, Veronica
author_facet Hong, Christopher
Chiang, Veronica
author_sort Hong, Christopher
collection PubMed
description Laser interstitial thermal therapy (LITT) is an effective treatment for regrowing lesions after previous radiosurgery to brain metastases, typically resulting in decreased perilesional edema within weeks followed by delayed reduction in lesion size. We have anecdotally observed that patients on immunotherapy (IT) at time of LITT may exhibit a delayed edema resolution response to laser ablation. Post-operative imaging for cases of LITT, performed by the senior author from June 2012-July 2019, for regrowing lesions after prior radiosurgery for brain metastases were retrospectively reviewed. The IT group was defined as any patient receiving IT treatment within 3 months of LITT. Post-operative MRIs obtained at serial time points after surgery (2 weeks, 6 weeks, 3 months, 6 months, and 12 months) were reviewed for treatment response to LITT, defined as change in surrounding edema on T2 FLAIR and change of lesion size on T1-weighted post-contrast images. Out of 60 ablated lesions, 22 were in the IT and 38 were in the non-IT groups. There were no differences in distribution of original cancer pathology (IT: 9 melanoma, 8 lung, 5 other, non-IT: 6 melanoma, 20 lung, 12 other; p>0.05). Time to lesion size response on T1-weighted post-contrast MRI neared but did not reach statistical significance between the IT and non-IT groups: median 3.0 versus 2.25 months (HR 1.5, 0.8–2.5, 95% CI, p=0.08), respectively. However, time to reduction of perilesional edema on T2-weighted MRI was significantly longer in the IT group, compared to the non-IT group: median 2.25 versus 1.5 months (HR 1.5, 0.9–2.5, 95% CI, p=0.04), respectively. These data suggest that IT around the time of LITT may lead to delayed edema reduction on MRI after LITT. We hypothesize IT may enhance normal immune-mediated mechanisms thus increasing perilesional inflammation after LITT. Further studies are needed to corroborate our observations and explore the underlying pathophysiology.
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spelling pubmed-74013612020-08-06 14. DELAYED MRI RESPONSE TO LITT IN PATIENTS UNDERGOING IMMUNOTHERAPY Hong, Christopher Chiang, Veronica Neurooncol Adv Supplement Abstracts Laser interstitial thermal therapy (LITT) is an effective treatment for regrowing lesions after previous radiosurgery to brain metastases, typically resulting in decreased perilesional edema within weeks followed by delayed reduction in lesion size. We have anecdotally observed that patients on immunotherapy (IT) at time of LITT may exhibit a delayed edema resolution response to laser ablation. Post-operative imaging for cases of LITT, performed by the senior author from June 2012-July 2019, for regrowing lesions after prior radiosurgery for brain metastases were retrospectively reviewed. The IT group was defined as any patient receiving IT treatment within 3 months of LITT. Post-operative MRIs obtained at serial time points after surgery (2 weeks, 6 weeks, 3 months, 6 months, and 12 months) were reviewed for treatment response to LITT, defined as change in surrounding edema on T2 FLAIR and change of lesion size on T1-weighted post-contrast images. Out of 60 ablated lesions, 22 were in the IT and 38 were in the non-IT groups. There were no differences in distribution of original cancer pathology (IT: 9 melanoma, 8 lung, 5 other, non-IT: 6 melanoma, 20 lung, 12 other; p>0.05). Time to lesion size response on T1-weighted post-contrast MRI neared but did not reach statistical significance between the IT and non-IT groups: median 3.0 versus 2.25 months (HR 1.5, 0.8–2.5, 95% CI, p=0.08), respectively. However, time to reduction of perilesional edema on T2-weighted MRI was significantly longer in the IT group, compared to the non-IT group: median 2.25 versus 1.5 months (HR 1.5, 0.9–2.5, 95% CI, p=0.04), respectively. These data suggest that IT around the time of LITT may lead to delayed edema reduction on MRI after LITT. We hypothesize IT may enhance normal immune-mediated mechanisms thus increasing perilesional inflammation after LITT. Further studies are needed to corroborate our observations and explore the underlying pathophysiology. Oxford University Press 2020-08-04 /pmc/articles/PMC7401361/ http://dx.doi.org/10.1093/noajnl/vdaa073.006 Text en © The Author(s) 2020. Published by Oxford University Press on behalf of the Society for Neuro-Oncology. http://creativecommons.org/licenses/by-nc/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Supplement Abstracts
Hong, Christopher
Chiang, Veronica
14. DELAYED MRI RESPONSE TO LITT IN PATIENTS UNDERGOING IMMUNOTHERAPY
title 14. DELAYED MRI RESPONSE TO LITT IN PATIENTS UNDERGOING IMMUNOTHERAPY
title_full 14. DELAYED MRI RESPONSE TO LITT IN PATIENTS UNDERGOING IMMUNOTHERAPY
title_fullStr 14. DELAYED MRI RESPONSE TO LITT IN PATIENTS UNDERGOING IMMUNOTHERAPY
title_full_unstemmed 14. DELAYED MRI RESPONSE TO LITT IN PATIENTS UNDERGOING IMMUNOTHERAPY
title_short 14. DELAYED MRI RESPONSE TO LITT IN PATIENTS UNDERGOING IMMUNOTHERAPY
title_sort 14. delayed mri response to litt in patients undergoing immunotherapy
topic Supplement Abstracts
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7401361/
http://dx.doi.org/10.1093/noajnl/vdaa073.006
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