Laser interstitial thermal therapy for high-grade glioma: a systematic review, meta-analysis, and meta-regression.

Abstract

Objective: Despite advances in the management of high-grade glioma (HGG), overall survival (OS) and progressionfree survival (PFS) remain suboptimal given the aggressive nature of these tumors. Difficult-to-access tumor locations, high complication rates, and high tumor progression rates further complicate the treatment of HGG. Herein, the authors aimed to comprehensively evaluate the safety and efficacy of laser interstitial thermal therapy (LITT) for HGG.

Methods: A systematic review of the literature was conducted through four electronic databases (Web of Science, PubMed, Embase, and the Cochrane Library) to identify studies on LITT for HGG treatment. Binary and continuous outcomes were assessed using odds ratios, mean differences, and 95% confidence intervals. Meta-regression was conducted to determine the source of heterogeneity and to assess predictors of key outcomes with high heterogeneity.

Results: Twenty-one studies with 602 patients harboring HGG were included in this review. Mean OS following LITT was 11.74 months (95% CI 10.9-12.6 months), with 6-, 12-, and 24-month OS rates of 77.0% (95% CI 65.8%-86.6%), 48.9% (95% CI 40.5%-57.3%), and 16.1% (95% CI 10.7%-22.3%), respectively. Mean PFS was 5.3 months (95% CI 4.97-5.7 months), with 6-, 12-, and 24-month PFS rates of 37.1% (95% CI 24.3%-44.6%), 12.8% (95% CI 8.7%-17.5%), and 4.3% (95% CI 2.2%-6.9%), respectively. Postoperative permanent deficits occurred in 5.7% of patients (95% CI 0.85%-13.1%). Subgroup analysis showed that LITT for deep and unresectable HGG had a 12-month OS rate of 53.0% (95% CI 20.0%-84.7%) and 12-month PFS rate of 12.9% (95% CI 0.02%-38.3%). Additionally, newly diagnosed HGG had a significantly higher rate of permanent deficits (4.15%, 95% CI 0.4%-10.2%) than recurrent HGG (0.02%, 95% CI 0.0%-2.2%; p = 0.023). Sensitivity analysis showed significantly higher 6-month OS in newly diagnosed cases (p = 0.0069), with no differences in OS, PFS, post-LITT tumor progression, Karnofsky Performance Status change from baseline, or temporary deficits.

Conclusions: LITT is an effective treatment for HGGs, with an acceptable safety profile. However, further randomized prospective studies are necessary to validate these findings and establish the procedure's long-term efficacy.