Health Technology Brief

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Laser Interstitial Thermal Therapy (LITT) for Treatment of Glioblastoma in Adults

September 20, 2019

Health Problem: Glioblastoma (GBM) is the most prevalent primary malignant intracranial tumor, representing as much as 16% of primary brain tumors. GBM is a fast-growing aggressive glioma that develops from glial cells in the brain. The overall prognosis is poor and even with the best standard of care, the median survival for adults with GBM ranges from 11 to 15 months and 5 to 7 months for recurrent disease. The current standard care for newly diagnosed GBM is surgery, followed by chemotherapy with temozolomide (TMZ) in combination with radiation therapy, and then ongoing maintenance treatment with TMZ. Virtually all patients with newly diagnosed GBM relapse, for which the treatment options are very limited.  
 

Technology Description: Laser interstitial thermal therapy (LITT) is a minimally invasive transcutaneous technique for treating intracranial lesions, such as GBM. LITT uses laser energy to ablate tumor tissue and is a potential treatment option for patients with GBM who are either not candidates for surgical resection or who have lesions in difficult-to-access or eloquent regions of the brain. LITT is paired with magnetic resonance imaging (MRI) to precisely monitor and control the thermal damage zone, thereby minimizing damage to adjacent healthy tissue. The laser catheter enters the brain through a small burr hole in the scalp and laser ablation commences according to the treatment plan and with close monitoring of the thermal damage zones by real-time MRI thermography. Patients are typically discharged within a few days of the procedure.
 

Controversy: The standard treatment for GBM is surgical resection; however, the locations of some tumors present too great a risk for this treatment option. Additionally, anatomical considerations or the general health of the patient may preclude an open surgical procedure. LITT represents a minimally invasive method for reducing the tumor mass and, when performed in conjunction with real-time MRI, can precisely avoid damaging eloquent areas of the brain. However, the efficacy and safety of LITT for GBM has yet to be determined.
 

Key Questions: 

  • Is LITT effective in increasing survival and quality of life in patients with GBM? 
  • How does LITT compare with alternative treatments for patients with GBM?
  • Is LITT safe?
  • Have definitive patient selection criteria been identified for LITT?