The history of LITT for the treatment of active brain metastasis and radiation necrosis.

Abstract

Treatment of brain metastasis has traditionally included surgical resection for single lesions in accessible locations. However, multiple lesions, small size, location within deeper structures or need for transgression of eloquent cortex renders surgical resection a less viable option. Stereotactic radiosurgery and whole brain radiation are additional treatment options, however risks of worsening neurocognitive symptoms, post-radiation edema, and most significant, radiation necrosis are apparent. With advances in minimally invasive laser delivery systems and magnetic resonance imaging, laser interstitial thermal therapy (LITT) has become an increasingly popular option for brain metastasis and radiation necrosis. This chapter will review the history and physics of LITT, discuss pioneering cases which pushed the boundaries of this therapy, and seminal trials which have explored its efficacy in treating brain metastasis and radiation necrosis.