STEREOTACTIC LASER ABLATION (SLA) FOLLOWED BY CONSOLIDATION STEREOTACTIC RADIOSURGERY (SRS) AS A TREATMENT STRATEGY FOR BRAIN METASTASIS THAT RECURRED LOCALLY AFTER INITIAL RADIOSURGERY (BMRS)

Abstract INTRODUCTION In independent clinical trials, ~30% of brain metastases recur locally after radiosurgery (BMRS). For these lesions, treatment with stereotactic laser ablation (SLA, also known as laser interstitial thermal therapy (LITT)) alone achieves a 12-month local control (LC12) of 54-85% while repeat SRS achieved LC12 of 54-79%. Here, we report favorable outcomes for BMRS treated with SLA followed by consolidation radiosurgery (SLA/cSRS). METHODS Clinical outcome of 18 patients with 19 histologically confirmed BMRS treated with SLA followed by consolidation SRS and >3 months follow-up were collected retrospectively across three institutions. Local control was defined as stability or decrease in contrast-enhancing (CE) and FLAIR volume. RESULTS SLA achieved ablation of 73-100% of the BMRS CE volumes. Consolidation hypo-fractionated radiosurgery (5 Gy x 5 or 6 Gy x 5) was carried out 16-40 days post-SLA (median of 26 days). With a median follow-up of 185 days (range: 93-1367 days) and median overall survival (OS) of 185 days (range: 99-1367 days), 100% LC12 was achieved. 13/18 (72%) patients that required steroid therapy prior to SLA/cSRS were successfully weaned off steroid by three months post-SLA/cSRS. Post-SLA, KPS declined for 3/19 (16%) patients and improved for 1/19 (5%) patients. No KPS changes occurred subsequent to consolidation SRS. There were no 30-day mortalities or wound complications. Two patients required re-admission within 30 days of SRS (severe headache that resolved with steroid therapy (n=1) and new-onset seizure (n=1)). Except for two patients who suffered histologically confirmed, local failure at 649 and 899 days, all other patients are either alive (n=6) or died from systemic disease progression (n=10). None of the treated patients developed symptomatic radiation necrosis. CONCLUSIONS This collaborative institutional experience support efficacy and safety of SLA followed by consolidation SRS as a treatment for BMRS. The treatment strategy warrants further investigations.