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Neurooncol Adv
Neurooncol Adv
noa
Neuro-Oncology Advances
2632-2498
Oxford University Press US

10.1093/noajnl/vdae090.129
vdae090.129
Final Category: Surgical Advances and Device Advances
AcademicSubjects/MED00300
AcademicSubjects/MED00310
SRGD-04 FUNCTIONAL OUTCOMES FOLLOWING LASER ABLATION VERSUS RESECTION OF MOTOR CORTEX METASTASES
Jackson Joshua Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA

Haskell-Mendoza Aden Duke University School of Medicine, Durham, NC, USA

Flusche Ann Marie Duke University School of Medicine, Durham, NC, USA

Woo Joshua Duke University School of Medicine, Durham, NC, USA

Gonzalez Ariel Duke University School of Medicine, Durham, NC, USA

Reason Ellery Duke University School of Medicine, Durham, NC, USA

Srinivasan Ethan Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, MD, USA

Lerner Emily Duke University School of Medicine, Durham, NC, USA

Edwards Ryan Duke University School of Medicine, Durham, NC, USA

Huie David Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA

Calabrese Evan Department of Radiology, Duke University Medical Center, Durham, NC, USA

Fecci Peter Preston Robert Tisch Brain Tumor Center, Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA

8 2024
02 8 2024
02 8 2024
6 Suppl 1 2024 SNO/ASCO CNS Metastases Conference i39i39
© The Author(s) 2024. Published by Oxford University Press, the Society for Neuro-Oncology and the European Association of Neuro-Oncology.
2024
https://creativecommons.org/licenses/by-nc/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

Abstract

BACKGROUND

Laser interstitial thermal therapy (LITT) has clinical utility in treating radiographically progressive brain metastases (BM) following stereotactic radiosurgery (SRS), while resection has been reserved for large, symptomatic lesions in the upfront setting. Resection-associated morbidity in eloquently-located metastases may hinder definitive management.

METHODS

Patients receiving resection or LITT for BM radiographically associated with the primary motor cortex (PMC) from 2015-2023 were retrospectively reviewed. Clinicodemographic and survival data were collected, with patient Karnofsky Performance Status (KPS) or modified Rankin Scale (mRS) scores assessed out to 1-year by independent raters.

RESULTS

Forty-one patients underwent resection and 30 underwent LITT to a PMC-associated lesion. Median age was 67 (range 38 – 80) vs 65 (44 – 80) for resection vs LITT; median pre-operative KPS (70 vs 80, P = 0.1) or mRS (2 vs 2, P = 0.66) did not differ between groups. Lung was the most common primary site (56.1% resections vs 56.7% LITTs). Resected lesions were of larger median diameter than LITT, 2.8 vs 1.9 cm, P = 0.0001. For resections, length of stay was longer, median 2 vs 1 day, P = 0.0002, and ICU use more frequent (75.6% versus 20.0%, P < 0.0001). At 1-month post-op, 66.7% of resection patients and 51.7% of LITT patients had stable or improved symptoms from pre-op, P = 0.21, with parity at 3-months (65.7% vs 62.9%). Further, there was no significant decrement in KPS or mRS score out to a year for either intervention.

CONCLUSION

While LITT-induced edema may slightly increase the risk of post-operative neurologic deficits, this is a transient and clinically insignificant phenomenon. Reduced operative footprint in the context of LITT may allow for faster definitive management of BM. For carefully selected lesions, LITT adjacent to eloquent cortex is feasible.
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