Laser Interstitial Thermal Therapy for Intracranial Lesions and Epilepsy: A Review of the Clinical Effectiveness, Cost-Effectiveness, and Guidelines


( Last Updated : September 29, 2015)
Project Line:
Health Technology Review
Project Sub Line:
Summary with Critical Appraisal
Project Number:
RC0707-000

Details


Question

  1. What is the clinical effectiveness and safety of laser interstitial thermal therapy for patients with intracranial lesions or epilepsy?
  2. What is the cost-effectiveness of laser interstitial thermal therapy for patients with intracranial lesions or epilepsy?
  3. What are the evidence-based guidelines regarding the use of laser interstitial thermal therapy for patients with intracranial lesions or epilepsy?

Key Message

The quantity and quality of the available evidence for the clinical efficacy of laser interstitial thermal therapy is limited. One randomized controlled trial, published in 1998, was identified by the included systematic review. The trial demonstrated that laser interstitial thermal therapy improved survival and increased the time to progression for glioblastoma multiform patients when used as an adjunct therapy. Additionally, two recent prospective cohort controlled studies demonstrated that laser interstitial thermal therapy had similar seizure outcomes to anterior mesial temporal lobe resection for the treatment of epilepsy. These studies also presented conflicting evidence regarding a decreased cognitive decline associated with laser interstitial thermal therapy as compared to anterior mesial temporal lobe resection. One small study found that observed efficacy was associated with decreased surgery time, decreased length of hospital stay, and decreased requirement for pain control. The systematic review and two health technology assessments concluded that laser interstitial thermal therapy had an acceptable complication profile but that more evidence for comparative clinical efficacy was required. Increased operating room and total hospitalization costs were associated with laser interstitial thermal therapy as compared to an open surgical procedure in one prospective cohort controlled study. No cost-effectiveness studies or guidelines on the use of laser interstitial thermal therapy were identified.