Hybrid Therapy for Newly Diagnosed and Recurrent Glioblastoma: Staged Procedure Integrating Open Surgical Resection With Laser Interstitial Thermal Therapy.

Abstract

Background and objectives: Glioblastoma (GBM) is the most common and aggressive primary malignant brain tumor in adults with a median overall survival of 15.6 months. Despite advancements, 5-year survival rates have not significantly improved. Laser interstitial thermal therapy (LITT) has been used to treat both newly diagnosed (nGBM) and recurrent GBM (rGBM) with demonstrable safety and efficacy. Traditionally, LITT has been limited to smaller lesions given physical and thermal constraints. We present 2 case examples of a novel, hybrid treatment approach to GBM, using both surgery and laser ablation as part of a staged procedure.

Methods: Two geriatric (older than 65 years) patients with nGBM or rGBM were treated with surgical resection followed by LITT the subsequent day. Both patients underwent preoperative MRI showing multifocal disease with a dominant component, causing mass effect in the second case, and an unresectable component.

Results: The first case underwent surgical resection of a large, multicentric rGBM in the parieto-occipital region, followed by LITT of an unresectable lesion in the inferior temporal gyrus. The second patient underwent surgical resection of the dominant temporal lobe component and LITT of the insular component. Neither patient had intraoperative or ablation complications. Both patients had stable postoperative neurological examinations and were discharged on the day after ablation, with no new deficits at follow-up.

Conclusion: The prognosis for GBM remains dismal despite attempts at advancements in patient management. Surgical resection is a critical component of the GBM treatment paradigm, although, alone, is not sufficient for maximal therapeutics in many patients. LITT is a minimally invasive means of cytoreduction that has shown promise for improving GBM outcomes. We demonstrate a novel, hybrid approach to GBM using hybrid surgical resection and LITT in a staged procedure to overcome traditional constraints of both open resection or LITT alone.