Dana-Farber / Brigham and Women's Cancer Center

Image-guided Laser Ablation Provides Innovative Treatment Option for Primary and Metastatic Brain Tumors and Radiation Necrosis

Experts in neurosurgery and radiology at Dana-Farber/ Brigham and Women’s Cancer Center are delivering interstitial laser ablation for the treatment of a range of intracranial lesions, including primary and metastatic tumors and radiation necrosis, using a novel combination of imaging and ablative techniques in the Advanced Multimodality Image Guided Operating (AMIGO) suite at Brigham and Women’s Hospital (BWH).

“With our approach, the patient remains in the bore of the MR scanner throughout the procedure, enabling the most accurate placement of the laser and continuous MR imaging and temperature mapping for real-time guidance during treatment,” said neurosurgeon Alexandra J. Golby, MD, Director of Image-guided Neurosurgery and Clinical Co-director of the AMIGO suite. “This technique is especially useful in reaching lesions deep in the brain that are otherwise difficult to access with other treatment methods.”

Dr. Golby is collaborating with radiologist Ferenc A. Jolesz, MD, Co-Principal Investigator of the National Center for Image-Guided Therapy at BWH and Co-Director of the AMIGO suite, to evaluate the efficacy of interstitial laser ablation in patients with recurrent brain metastases and radiation necrosis.

AMIGO Suite

Amigo Suite
The nation’s first fully integrated operating suite to offer immediate intra-procedural access to an extensive range of advanced imaging modalities, AMIGO’s 5,700-square foot space is divided into three interconnected procedure rooms housing real-time anatomic, functional, and molecular imaging modalities, including MRI, PET/CT, fluoroscopy, and ultrasound. Visit www.brighamandwomens.org/AMIGO to learn more about AMIGO.

Real-time Guidance and Monitoring

During interstitial laser ablation, a cooling catheter is inserted into the brain via a stereotactic approach. Placement is confirmed with magnetic resonance (MR) imaging, and a laser fiber is passed through the catheter. MR imaging is continuously repeated, and heat testing is performed at a low level
to confirm parameters. Real-time temperature mapping is provided with MR imaging, and ablation is monitored with MR imaging and software that outlines damage to the treatment area. Flexibility in positioning of the laser fiber enables surgeons to begin the approach at the middle or the edge of the target area and to reposition the catheter as necessary throughout the procedure.

Interstitial laser ablation may be employed as part of an individualized treatment plan for patients with:

  • Benign and malignant primary brain tumors;
  • Metastatic brain lesions, including recurrent disease;
  • Radiation necrosis.

About the Center for Neuro-Oncology

The multidisciplinary team in the Center for Neuro-Oncology at Dana-Farber/Brigham and Women’s Cancer Center is comprised of subspecialty experts in neuro-oncology, neurosurgery, radiation oncology, neuroradiology, and neuropathology who collaborate to deliver advanced care for patients with central nervous system cancers. The team leads an average of 20 clinical trials at a given time, including trials that are rapidly expanding the availability of targeted therapies and improving the standard of care for patients.

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Case Study

Addressing Recurrent Metastatic Disease after Radiation

Background:
A 49-year-old woman with metastatic melanoma presented with recurrence of a deep brain lesion adjacent to the ventricle (Image 1). A PET/CT scan showed hypermetabolism in the brain, confirming suspicion of disease recurrence. The lesion had previously been treated with radiosurgery and
whole brain radiation. The patient’s systemic disease was otherwise controlled.

Approach:
The patient was not an appropriate candidate for additional radiation therapy. Given the position of the lesion, standard resection would be highly invasive and pose risks of infection and cerebrospinal fluid (CSF) leak. The patient was treated with image-guided interstitial laser ablation in the AMIGO suite at BWH. After fine targeting (Image 2) and placement of the laser fiber, heat testing was performed (Image 3). Following the first ablation (Image 4), damage to the lesion was assessed and a second ablation
lasting 42 seconds was performed (Image 5). A final scan in AMIGO confirmed complete treatment of the lesion (Image 6). The patient was discharged home the next day.

Follow up:
At four months post-procedure, the patient’s scan showed no evidence of disease recurrence.

Image 1

Image 1

 

Image 2

Image 2

 

Image 3

Image 3

 

Image 4

Image 4


Image 5

Image 5

 

Image 6
Image 6

 

 

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