Surgical Management of Recurrent Brain Metastasis: A Systematic Review of Laser Interstitial Thermal Therapy

SIMPLE SUMMARY: Advances in surgical techniques, radiation therapy and systemic therapies have greatly improved survival among patients with brain metastases. Prolonged survival inevitably leads to an increased incidence of local disease recurrence. The management of recurrent brain metastases is not uniform. Treatment modalities include re-resection, irradiation, alternate systemic therapy regimens and, more recently, laser interstitial thermal therapy. Laser interstitial thermal therapy, or LITT, may offer an effective surgical alternative to traditional craniotomy for resection, particularly in the setting of a patient that is unable to tolerate open surgery or with a deep-seated brain metastasis that is not amenable to surgical resection. This review aims to evaluate the available literature regarding the use of LITT specifically for recurrent intracranial disease. ABSTRACT: The incidence of recurrent metastatic brain tumors is increasing due to advances in local therapy, including surgical and radiosurgical management, as well as improved systemic disease control. The management of recurrent brain metastases was previously limited to open resection and/or irradiation. In recent years, laser interstitial thermal therapy (LITT) has become a promising treatment modality. As systemic and intracranial disease burden increases in a patient, patients may no longer be candidates for surgical resection. LITT offers a relatively minimally invasive option for patients that cannot tolerate or do not want open surgery, as well as an option for accessing deep-seated tumors that may be difficult to access via craniotomy. This manuscript aims to critically review the available data regarding the use of LITT for recurrent intracranial brain metastasis. Ten of seventy-two studies met the criteria for review. Generally, the available literature suggests that LITT is a safe and feasible option for the treatment of recurrent brain metastases involving supratentorial and cortical brain, as well as posterior fossa and deep-seated locations. Among all studies, only one directly compared craniotomy to LITT in the setting of recurrent brain metastasis. Prospective studies are needed to better elucidate the role of LITT in the management of recurrent brain metastases.