Whole-brain
radiotherapy and stereotactic radiosurgery (SRS) play a central role in the treatment of metastatic
brain tumors. Radiation
necrosis occurs in 5% of patients and can be very difficult to treat. The available treatment options for radiation
necrosis include prolonged high-dose
corticosteroids, hyperbaric
oxygen, anticoagulation,
bevacizumab, and surgical resection. We present the first report and results using
laser-interstitial thermal
therapy (LITT) for medically refractory radionecrosis. A 74-year-old diabetic patient who had a history of
non-small cell lung cancer with
brain metastases and subsequent treatment with SRS, presented with a focal lesion in the left centrum semiovale with progressively worsening
edema. Image findings were consistent with radiation
necrosis that was refractory despite prolonged, high-dose
steroid therapy. His associated comorbidities obviated alternative interventions and the lesion was not in a location amenable to surgical resection. We used
laser thermal ablation to treat the biopsy-proven radionecrosis. The procedure was tolerated well and the patient was discharged 48 hours postoperatively. Imaging at 7-week follow-up showed near complete resolution of the
edema and associated mass effect. Additionally, the patient was completely weaned off
steroids. To our knowledge this is the first report using LITT for the treatment of focal radiation
necrosis. LITT may be an effective treatment modality for patients with medically refractory radiation
necrosis with lesions not amenable to
surgical decompression.