Long-term Survival in Single Lesion New or Recurrent Glioblastoma Multiforme (GBM) and Metastasis Following Laser Interstitial Thermal Therapy (LITT)

Introduction: Single-lesion glioblastoma multiforme (GBM) and brain metastases can appear similar on imaging but require different treatments. This study aimed to evaluate outcomes of laser interstitial thermal therapy (LITT) in patients with newly diagnosed versus recurrent neoplasms.

Methods: An institutional retrospective review (2012–2024) was conducted on patients with single-lesion GBM or metastases treated with LITT. Data on demographics, tumor characteristics, operative reports, and pre/postoperative variables were analyzed using multiple linear regression (p < 0.05) on StataIC16.1.

Results: Among 144 patients, 99 had GBM (64 new, 35 recurrent) and 45 had metastases (41 new, 4 recurrent). There were no differences in gender (56.6% male), tumor laterality (52% left), preoperative deficits (75.8% - headaches, cognitive/motor deficits) or tumor locations (34.7% frontal, 26.4%, temporal, 22.9% parietal, cerebellar 5.6%, deep brain structures 4.9% or occipital 4.2%).

Newly diagnosed GBM patients were older (67.1 vs. 58.3 years), had smaller tumors (3.5 vs. 4.8 cm), fewer complications (18.8% vs. 28.6%), lower total mortality (28.1% vs 40.0%), but shorter progression-free survival (PFS) (2.4 vs. 5.1 months) than recurrent GBM cases. No difference in pre/post KPS (80.5/81.1 vs 79.7/82.6), intraoperative complications (6.3% vs 8.6%), or higher thirty-day readmission (10.9% vs 8.6%) were observed. Preoperative chemotherapy, steroids, and glucose control slightly improved PFS, though not significantly beyond 12 months.

For metastases, newly diagnosed cases had larger tumors (3.7 vs. 1.2 cm) and younger patients (60.1 vs. 64.2 years). No difference in pre/post KPS (83.9/84.3 vs 85.0/85.0) was observed. Recurrent metastases had longer PFS (11.3 vs. 4.7 months) and higher mortality (75.0% vs. 29.7%). Trends suggested that preoperative chemotherapy and avoiding steroids improved PFS.

Conclusion : Recurrent GBM and metastases had better PFS after LITT than newly diagnosed cases. Preoperative chemotherapy, steroids, and glucose control warrant further investigation for their potential to improve PFS across different tumor types.