1. LITT for biopsy proven radiation necrosis: A qualitative systematic review.
- Author
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Cuschieri, Andrea, Borg, Mariah, Levinskaia, Eliza, and Zammit, Christian
- Abstract
• The incidence of radiation necrosis is increasing, necessitating more efficacious treatment modalities. • LITT has emerged as a promising second-line treatment against RN, with significant advantages namely same-day biopsy and improved patient outcomes improved lesion control. • The incongruence in outcome reporting adds to the uncertainty in adopting LITT as a novel approach as a possible surgical intervention. • Future studies should closely mirror results reported by published literature, while addressing their limitations, to facilitate the generalisability of patient outcomes across studies. With the widespread use of stereotactic radiosurgery (SRS), post-radiation treatment effects (PTREs) are increasing in prevalence. Radiation necrosis (RN) is a serious PTRE which carries a poor prognosis. Since 2012, laser interstitial thermal therapy (LITT) has been used to treat RN. However, reviews have attempting to generalise the efficacy of LITT against biopsy-proven RN are limited. In this systematic review, patient demographic characteristics and post-LITT clinical outcomes are characterised. A systematic literature search was conducted in four major databases for cohort studies and case reports published between 2012 and 2022, following the PRISMA 2020 checklist. Data was extracted and descriptively analysed. Quality of reporting was assessed using the PROCESS criteria and reporting bias was evaluated using the ROBINS-I scoring system. Eleven studies met our inclusion criteria, with an overall moderate risk of reporting bias being observed. Mean pre-LITT target lesion volume was 6.75 cm
3 , and was independent of gender, time since SRS, age and number of interventions prior to LITT. LITT is a versatile treatment option which may be used to treat a vast range of patients with refractory biopsy-proven RN. However, neurosurgeons should exercise caution when selecting patients for LITT due to insufficient data on the treatment's efficacy against biopsy-proven RN. This warrants further studies to unequivocally determine the safety and clinical outcomes. [ABSTRACT FROM AUTHOR]- Published
- 2023
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