DESCRIPTION
Laser-induced thermal ablation, also known as, laser interstitial thermal therapy [LITT], is proposed as a less invasive treatment option compared to surgery for neurological indications such as brain tumors, epilepsy, or radiation necrosis. The goal of therapy is selective thermal injury through the maintenance of a sharp thermal border, as monitored via the parallel use of real-time magnetic resonance (MR) thermography and controlled with the use of actively cooled applicators. In neurological applications, LITT involves the creation of a transcranial burr hole for the placement of the laser probe at the target brain tissue. Probe position, ablation time, and intensity are controlled under magnetic resonance imaging (MRI) guidance. Examples of FDA approved devices include NeuroBlate® and Visualase®.
POLICY
MRI-guided laser-induced thermotherapy for any use is considered investigational.
IMPORTANT REMINDERS
Any specific products referenced in this policy are just examples and are intended for illustrative purposes only. It is not intended to be a recommendation of one product over another, and is not intended to represent a complete listing of all products available. These examples are contained in the parenthetical e.g. statement.
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ADDITIONAL INFORMATION
Evidence is insufficient to determine whether this technology works as well or better than alternative therapies. This technology’s effect on survival and quality of life is unknown and can best be addressed through comparative studies.
SOURCES
American College of Radiology/American Society of Neuroradiology. (2019). ACR_ASNR practice parameter for the performance of non-breast magnetic resonance imaging (MRI) guided procedures. Retrieved October 8, 2019 from https://www.acr.org.
American Society of Clinical Oncology (ASCO), the Society for Neuro-Oncology (SNO), and the American Society for Radiation Oncology (ASTRO). (2022). Treatment for brain metastases: ASCO-SNO-ASTRO guideline. Retrieved August 25, 2023 from https://www.asco.org.
BlueCross BlueShield Association. Evidence Positioning System. (1:2023). Laser interstitial thermal therapy for neurological conditions. (7.01.170). Retrieved August 24, 2023 from https://www.bcbsaoca.com/eps/. (42 articles and/or guidelines reviewed)
Chen, C., Guo, Y., Chen, Y., Li, Y., & Chen, J. (2021). The efficacy of laser interstitial thermal therapy for brain metastases with in-field recurrence following SRS: systemic review and meta-analysis. International Journal of Hyperthermia: The Official Journal of European Society for Hyperthermic Oncology, North American Hyperthermia Group, 38 (1), 273–281. (Level 2 evidence)
de Franca, S.A., Tavares, W.M., Salinet, A.S.M., Teixeira, M.J., & Paiva, W.S. (2020). Laser interstitial thermal therapy as an adjunct therapy in brain tumors: A meta-analysis and comparison with stereotactic radiotherapy. Surgical Neurology International, 11, 360. (Level 2 evidence)
Epilepsy Foundation. (2020). Magnetic-resonance-guided laser interstitial thermal therapy (MR-g LITT). Retrieved September 1, 2020 from https://www.epilepsy.com.
Kohlhase, K., Zöllner, J., Tandon, N., Strzelczyk, A., & Rosenow, F. (2021). Comparison of minimally invasive and traditional surgical approaches for refractory mesial temporal lobe epilepsy: A systematic review and meta-analysis of outcomes. Epilepsia, 62 (4), 831-845. (Level 1 evidence)
LaRiviere, M., & Gross, R. (2016). Stereotactic laser ablation for medically intractable epilepsy: the next generation of minimally invasive surgery. Frontiers in Surgery, Vol. 3, Article 64. (Level 2 evidence)
Marathe, K., Alim-Marvasti, A., Dahele, K., Xiao, F., Buck, S., O'Keeffe, A., et al. (2021). Resective, ablative and radiosurgical interventions for drug resistant mesial temporal lobe epilepsy: a systematic review and meta-analysis of outcomes. Frontiers in Neurology, 12, 777845. (Level 1 evidence)
National Comprehensive Cancer Network. (2023, March). NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®). Central nervous system cancers (V1.2023). Retrieved August 25, 2023 from the National Comprehensive Cancer Network.
National Institute for Health and Care Excellence. (2020, March). MRI-guided laser interstitial thermal therapy for drug-resistant epilepsy. Retrieved September 2, 2020 from www.nice.org.uk/guidance/dg10.
Palmisciano, P., Haider, A., Nwagwu, C., Wahood, W., Aoun, S., Abdullah, K., et al. (2021). Bevacizumab vs laser interstitial thermal therapy in cerebral radiation necrosis from brain metastases: a systematic review and meta-analysis. Journal of Neuro-oncology, 154 (1), 13–23. Abstract retrieved August 25, 2023 from PubMed database.
U. S. Food and Drug Administration. (2007, August). Center for Devices and Radiological Health. 510k Premarket Notification Database. K071328. Retrieved December 29, 2016 from http://www/fda/.gov.
U. S. Food and Drug Administration. (2013, April). Center for Devices and Radiological Health. 510k Premarket Notification Database. K120561. Retrieved December 29, 2016 from http://www/fda/.gov.
Viozzi, I., Guberinic, A., Overduin, C.G., Rovers, M.M., & Ter Laan, M. (2021). Laser interstitial thermal therapy in patients with newly diagnosed glioblastoma: A systematic review. Journal Clinical Medicine,10 (2), 355. (Level 2 evidence)
Wang, R., Beg, U., Padmanaban, V., Abel, T.J., Lipsman, N., Ibrahim. G.M., & Mansouri, A. (2021). A systematic review of minimally invasive procedures for mesial temporal lobe epilepsy: Too minimal, too fast? Neurosurgery, doi: 10.1093/neuros/nyab125. Epub ahead of print. Abstract retrieved May 6, 2021 from PubMed database.
Winifred S. Hayes. Health Technology Assessment. (2019, September; last updated October 2022). Laser interstitial thermal therapy (LITT) for treatment of glioblastoma in adults. Retrieved August 24, 2023 from http://www.Hayesinc.com/subscribers. (39 articles and/or guidelines reviewed).
Winifred S. Hayes. Health Technology Assessment. (2020, February; last updated January 2023). Laser interstitial thermal therapy (LITT) for refractory temporal lobe epilepsy. Retrieved August 24, 2023 from www.Hayesinc.com/subscribers. (47 articles and/or guidelines reviewed)
Xue, F., Chen, T., & Sun, H. (2018). Postoperative outcomes of magnetic resonance imaging (MRI)-guided laser interstitial thermal therapy (LITT) in the treatment of drug-resistant epilepsy: A meta-analysis. Medical Science Monitor: International Medical Journal of Experimental and Clinical Research, (24), 9292-9299. (Level 1 evidence)
ORIGINAL EFFECTIVE DATE: 6/11/2016
MOST RECENT REVIEW DATE: 10/12/2023
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