Laser Interstitial Thermal Therapy Achieves Lasting Tumor Control in Pediatric Patients with Low-Grade Glioma

Introduction: Surgical resection is considered a mainstay of treatment for pediatric patients with low-grade gliomas (LGG). However, LGG arising in eloquent cortex or in deep-seated regions represent a surgical challenge. Laser interstitial thermal therapy (LITT) has shown efficacy for treating lesions in anatomically- or functionally-challenging locations. However, studies describing the efficacy of LITT for treating pediatric patients with LGG are scarce.

Methods: We performed a single-institution retrospective chart review to identify all patients under age 25 who underwent LITT for the treatment of LGG. Patient demographics, lesion and treatment characteristics, and postoperative clinical and radiographic outcomes were collected.

Results: We identified 12 pediatric patients with LGG who were treated with LITT (n=12 lesions; mean volume 1.41.1cc). Lesions were subcortical in the frontal (n=7; 58%) or parietal (n=2; 17%) lobes, cerebellar (n=3; 25%), or thalamic (n=1; 8%). One patient had a prior resection of a cerebellar LGG that was further treated using LITT. In two patients (17%) with larger lesions, two-trajectory LITT was used. In eight patients (67%), a biopsy was performed immediately prior to LITT using the same trajectory. No technical challenges were noted. At last follow-up (mean 14mo, range 3-33mo), 11 patients (92%) experienced excellent local control (complete or partial response). One patient experienced disease progression three months after LITT and subsequently underwent open surgical resection. Transient neurological deficits were noted in two patients (one patient experienced transient ipsilateral hand weakness, and another experienced ataxia; both resolved within one month). There were no treatment-related mortalities or postoperative hemorrhages.

Conclusion : Pediatric patients with LGG can be safely and effectively treated with LITT. The relative benefits of LITT compared to other interventions for pediatric LGG remains to be elucidated, but LITT may hold promise for treating small, deep-seated lesions that are often seen in pediatric patients and for patients where a lesion biopsy is warranted.