Abstract
Abstract INTRODUCTION Laser interstitial thermal therapy (LITT) has shown increased patient survival and outcomes in glioblastoma multiforme (GBM). However, its safety and survival in large-volume GBM tumors has been poorly elucidated. OBJECTIVE To evaluate the use of LITT in large-volume GBMs. METHODS A retrospective cohort of adult patients with grade IV IDH-wt GBM measuring ≥ 10 cm3 who were treated with LITT was compared to a control group with volumes <10 cm3. A Kaplan-Meier analysis, followed by a Cox-proportional hazards model with overall survival (OS) as the timeline and death as the event, were performed with volume group, mFI-11 score, 30-day readmission, age at surgery (AOS), recurrent vs. primary lesions, and EOA as covariates. RESULTS The cohort consisted of 46 large-volume patients (mean: 22.0 cm3, STD: 10.8) with a mean age of 63 years and 57% male predominance, compared to 41 controls (mean: 4.4 cm3, STD: 2.8). Lesions were primary in 78% and 60%, and recurrent in 22% and 40%, of the large and small-volume groups, respectively. Kaplan-Meier analysis showed no significant survival difference between the large (OS=245 days) and small-volume (OS=358 days) groups (p=0.261). No covariate showed significant risk of hazard in the large compared to small-volume cohorts (p>0.05). Across the entire cohort, mFI-11 score, recurrent lesions, and EOA showed no significance as individual predictors of death (p>0.25). AOS (p<0.005) and 30-day readmission (p<0.005) showed significantly increased hazard for the entire cohort. Importantly, volume group did not significantly increase hazard (1.16 [0.68, 1.98], p=0.60). CONCLUSION This is the first study evaluating the safety and efficacy of LITT in large-volume GBMs, specifically, with a larger cohort than any existing analysis sub-grouped by volume. We show LITT can be safe and efficacious, without significantly increased mortality compared to in small-volume GBMs.