The Safety and Efficacy of Laser Interstitial Thermal Therapy for Newly Diagnosed Deep-Seated Low-Grade Glioma: A Pilot Study Comparing Outcomes With a Surgical Cohort.

Abstract

Laser interstitial thermal therapy (LITT) has emerged as a minimally invasive alternative to open craniotomy for patients deemed unsuitable for surgery due to deep-seated or eloquent lesion location, age, frailty, or comorbidities. However, its use in newly diagnosed deep-seated low-grade glioma (nLGG) has not been elucidated. We aimed to evaluate the safety and efficacy of LITT for deep-seated nLGG compared with a similar surgical cohort. We retrospectively reviewed patients with unifocal, deep-seated nLGG treated with either LITT or surgical resection between 2013 and 2024. Demographic, perioperative, and follow-up data were compared between groups. Kaplan-Meier assessed progression-free and overall survival outcomes. To address baseline tumor volume differences, a subset analysis was performed using a greedy nearest-neighbor algorithm to generate a 1:1 matched cohort based on tumor volume. A total of 15 patients in the study group (median age 46 [IQR: 34-53] years, 40.0% men) were compared with 51 patients (median age 38 [IQR: 29-54] years, 43.1% men) in the control group. There were no significant differences in in-hospital complications (P = .999), 30-day complications (P = .999), or complications between 30 days and 3 months (P = .713), new postoperative motor or speech deficits (0.999) between groups. Postoperative adjuvant chemotherapy (23.1% vs 46.9%, P = .217) and radiation (23.1% vs 44.7%, P = .210) rates did not differ significantly. Among high-risk patients, time to adjuvant chemotherapy (64.7 vs 77.7 days) and radiation (36.0 vs 53.6 days) was earlier in the LITT group, although not statistically significant. Kaplan-Meier analysis showed no statistically significant differences in progression-free survival or overall survival between groups. On matched pair analysis, there remained to be no statistically significant differences in outcomes observed between LITT and craniotomy groups. This pilot study is the first to suggest that LITT is a safe treatment option for patients with deep-seated nLGG, offering comparable outcomes with surgical resection.