Retrospective study of biopsy alone versus laser interstitial thermal therapy for butterfly gliomas

Butterfly gliomas are an aggressive subset of high-grade glioma characterized by bilateral hemispheric involvement. These patients often only receive biopsy followed by chemoradiation rather than surgical resection. Laser interstitial thermal therapy (LITT) provides a minimally invasive alternative that may improve survival. A retrospective study at the University of Miami (FL) Miller School of Medicine compared outcomes in biopsy alone (n=15) versus biopsy plus LITT (n=29) cohorts. LITT was associated with a longer median overall survival (14.86 versus 4.93 months; p=0.0489) and longer median progression-free survival (4.67 versus 2.53 months; p=0.0389) compared with biopsy. Within the LITT cohort, larger preoperative tumor volumes were associated with lower extent of ablation (EOA; r²=0.46; p=0.0002) and a higher residual tumor burden (RTB; r²=0.90; p<0.0001). Longer ablation times correlaterd with a larger EOA (r²=0.21; p=0.0320). Neither EOA nor RTB were associated with survival. Postoperative Karnofsky performance status improvement correlated with improved overall survival, with a similar trend in progression-free survival. Postoperative readmissions and complications were not statistically different between groups. The authors conclude that LITT is associated with improved survival compared with biopsy alone in patients with butterfly gliomas.