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Laser Interstitial Thermal Therapy for Epilepsy and/or Brain Tumours: A Review of Clinical Effectiveness and Cost-Effectiveness

Last updated: June 17, 2019
Project Number: RC1140-000
Product Line: Rapid Response
Research Type: Devices and Systems
Report Type: Summary with Critical Appraisal
Result type: Report

Question

  1. What is the clinical effectiveness and safety of Laser Interstitial Thermal Therapy for epilepsy and/or for brain tumours?
  2. What is the cost-effectiveness of Laser Interstitial Thermal Therapy for epilepsy and/or for brain tumours?

Key Message

This review provides evidence that expands upon information previously published by CADTH. Two recent systematic reviews and two prospective cohort studies were identified that addressed the clinical effectiveness and safety of Laser Interstitial Thermal Therapy (LITT) for epilepsy and/or brain tumours. Additionally, one economic evaluation was found that reported on the cost-effectiveness of LITT relative to open craniotomy with or without gliadel wafer, biopsy alone, or open craniotomy and biopsy. The systematic reviews though well-conducted, included mainly low-quality retrospective primary studies and the prospective studies did not provide comparative evidence on the use of LITT. There was heterogeneity in the patient populations, the configuration of the intervention, the outcomes of interest, and the respective follow-up periods, thereby precluding substantive synthesis. Four of the five studies were financially-sponsored by the manufacturer of one of the LITT systems and the lists of authors included consultants who were employed by the company. For these and other reasons, considerable caution must be taken in making inferences from the results presented in this report. In summary, the outcomes of interest were seizure freedom, disease progression and overall survival, quality of life, hospitalization, and adverse events. Evidence of limited quality and quantity suggested that LITT proffers no advantage over stereotactic radiosurgery in inducing seizure freedom in patients with drug-resistant, medically-intractable temporal lobe epilepsy. Relative to patients who were treated with stereotactic radiosurgery and craniotomy, patients treated with LITT appeared to experience fewer adverse events and complications. No comparative evidence on disease progression, overall survival, hospitalization, or quality of life was found. None of the studies reported on the incidence of epileptic episodes, post-operative pain, use of medication, or hospital readmissions. A Markov model-based economic analysis found that LITT was cost-effective relative to a combination of craniotomy and biopsy in treating high grade gliomas in or near areas of eloquence or deep seated tumours. The analysis remained robust to changes in incidence of local recurrence of glioblastomas, the cost of craniotomies for high grade gliomas, the probability of a subtotal resection, and the probability of using a gliadel wafer as adjunctive therapy following a craniotomy.