TY - JOUR
T1 - Laser interstitial thermal therapy for high-grade glioma
T2 - a systematic review, meta-analysis, and meta-regression
AU - Mortezaei, Ali
AU - Al-Saidi, Nadir
AU - Taghlabi, Khaled M.
AU - Hajikarimloo, Bardia
AU - Dib, Christie
AU - Hussein, Amna
AU - Abdelsalam, Ahmed
AU - Nemer, Paul
AU - Shepard, Matthew J.
AU - Sheehan, Jason P.
AU - Faraji, Amir H.
N1 - Publisher Copyright:
©AANS 2025, except where prohibited by US copyright law
PY - 2025
Y1 - 2025
N2 - 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. https://thejns.org/doi/abs/10.3171/2025.5.FOCUS25316
AB - 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. https://thejns.org/doi/abs/10.3171/2025.5.FOCUS25316
KW - LITT
KW - brain tumor
KW - high-grade glioma
KW - laser interstitial thermal therapy
UR - https://www.scopus.com/pages/publications/105012910287
UR - https://www.scopus.com/inward/citedby.url?scp=105012910287&partnerID=8YFLogxK
U2 - 10.3171/2025.5.FOCUS25316
DO - 10.3171/2025.5.FOCUS25316
M3 - Article
C2 - 40749231
AN - SCOPUS:105012910287
SN - 1092-0684
VL - 59
JO - Neurosurgical focus
JF - Neurosurgical focus
IS - 2
M1 - E10
ER -