EMBR-18. LASER INTERSTITIAL THERMAL THERAPY FOR RECURRENT MEDULLOBLASTOMA

BACKGROUND: Medulloblastoma is one of the most common malignant childhood brain tumors and is managed by maximal surgical resection followed by cranio-spinal irradiation and adjuvant chemotherapy. The estimates for survival have not significantly improved over the last two decades, and survivors have an increased risk of poor quality of life. Disease relapse occurs in around 30% of children and survival is less than 20%. Laser interstitial thermal therapy (LITT) is a minimally invasive approach that has been increasingly used to treat brain lesions, particularly for high-risk surgeries. While LITT has been described in a variety of primary brain tumors, including glioblastoma multiforme and metastatic brain tumors, there have been few reports of LITT for recurrent medulloblastoma. CASE DESCRIPTION: We describe a case of an 11-year-old female with recurrent medulloblastoma first treated at age 5. She initially underwent gross total resection complicated by severe posterior fossa syndrome followed by chemotherapy and radiation (per ACNS0332). She was unfortunately found to have a new enhancing lesion on surveillance imaging 6 years later, and a biopsy confirmed recurrent tumor. Due to morbidity from initial surgery, the family did not wish to pursue further open resection but agreed to proceed with laser ablation as an alternative. She continues on Avastin/irinotecan/TMZ. Surveillance MRI nearly a year later shows a significant reduction in tumor size and enhancement. CONCLUSION: Recurrent medulloblastoma is a highly aggressive tumor that conveys a poor prognosis. LITT offers a less invasive procedure that may serve as an adjunct in treating recurrent tumor or as palliation. Longer term follow-up and additional cases will help understand the efficacy of LITT in recurrent medulloblastoma.