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To assess the clinical results of LITT in patients with intracranial gliomas the authors performed a systematic literature review and identified reports of the application of such treatment with or without iMRI guidance. Several case series [13, 16, 19, 21, 22, 26, 28–35] and one randomized trial [36] were evaluated with a particular emphasis on general characteristics of the patient population, the World Health Organization (WHO) histopathological grade of tumors, perioperative morbidity and mortality, and reported outcomes. Every attempt was made to extract only information on gliomas, given the heterogeneity of studies, which frequently also included metastatic brain tumors and other non-gliomatous neoplasms.

The experience with LITT of LGG (mainly of WHO grade II) was highlighted in 7 articles [16, 19, 21, 22, 29, 30, 33], reporting 31 cases overall (Table 1). Mean age of patients was 43.9 years. Almost all tumors were <35 mm in diameter (while an exceptionally large neoplasm sized 30 × 50 mm was noted [16]) and were considered unresectable either because of location within eloquent brain or owing to a predicted high risk of surgery. LITT was usually applied as the primary option and was not followed by adjuvant postoperative therapy. In general, treatment was well tolerated and was not accompanied by permanent neurological deficit in any patient. In one series, mild-to-severe perilesional brain edema lasting in average 23 days after surgery was noted in 46% of patients [19]. During follow-up the majority of neoplasms demonstrated partial or complete response. One study reported a mean time-to-progression (TTP) and overall survival of 16 and 34 months, respectively [33].

The experience with LITT of HGG (WHO grades III and IV) has been highlighted in 12 articles [13, 16, 19, 21, 26, 28, 31–36], reporting 109 cases overall (Table 2). The age of patients varied from 24 to 78 years. All treated tumors were <50 mm in diameter. LITT was mainly applied for management of residual or recurrent neoplasms, when other treatment options had been exhausted. In general, thermal therapy was well tolerated. The most common complications were deep venous thrombosis, pulmonary embolism, and seizures, which occurred, on average, in 2.4, 3.5, and 4.7% of cases, respectively, with slightly higher risk in patients with recurrent tumors [13, 16, 26, 32–36]. Moderate perilesional brain edema after surgery was common [13, 16, 19, 31]. Transient postoperative neurological decline was occasionally noted, whereas permanent deficit was encountered in 0–10% of patients (on average 4.8%) [13, 16, 35, 36]. Length of hospital stay after LITT for recurrent glioblastomas multiforme (GBM) was shorter in comparison to tumor resection [26, 35]. During follow-up, tumors usually demonstrated volume reduction [13, 16, 19, 31]. In a randomized clinical trial Sneed et al. [36] noted significantly longer survival of patients with recurrent GBM after combination of LITT and brachytherapy (n = 35) in comparison to brachytherapy alone (n = 33). Several clinical series also demonstrated extended survival (with a range of its median values from 9.0 to 11.2 months) after LITT in patients with recurrent GBM refractory to other treatment and not suitable for re-resection, and showed that it was beneficial in comparison to best palliative care [13, 26, 28, 33, 35].

Table 1. Summary of reports on LITT in cases of low-grade gliomas

Tumor size has been a challenge for LITT. The majority of reported series on treated gliomas comprised lesions of <10 cm³ (which corresponds to a radius of 1.33 cm), and the same volume cut-off was associated with the best clinical outcomes [37]. LITT of larger neoplasms carries high risk of brain edema, which may be poorly tolerated. Nevertheless, more recent studies have addressed this fundamental challenge. Wright et al. [38] demonstrated that LITT can be combined with mini-craniotomy and transsulcal tumor resection, which may prevent clinical consequences of posttreatment brain swelling.

Table 2. Summary of reports on LITT in cases of high-grade gliomas

Finally, LITT-induced disruption of the BBB at the periphery of glioma and in the peritumoral brain may improve locoregional drug delivery during chemotherapy [39].