Minimally invasive laser surgery can extend survival by months and enhance quality of life for glioblastoma patients, according to new research published by Washington University School of Medicine in St. Louis. The technique, which utilizes real-time MRI guidance to target deep or recurrent brain tumors, offers a viable alternative to repeated open-skull operations.
Washington University Analysis Reveals Factors Driving Survival
For patients facing glioblastoma, one of the most aggressive and devastating forms of brain cancer, the standard path forward has long meant invasive open-skull surgery alongside chemotherapy and radiation. Over the past decade and a half, however, neurosurgeons have increasingly incorporated a minimally invasive alternative known as laser interstitial thermal therapy, or LITT. A major analysis led by researchers at Washington University School of Medicine in St. Louis examined patient outcomes from this procedure to identify the specific variables that maximize survival.
The study, published in the Journal of Clinical Oncology, focused on 787 brain tumor patients tracked across a prospective multicenter trial involving Siteman Cancer Center at Barnes-Jewish Hospital and WashU Medicine, alongside 24 other locations across the U.S. According to the data, the extent of tumor removal achieved by the laser and the precise timing of the intervention directly influence how long patients survive.
“Our goal is to both extend the survival of our brain tumor patients and improve the quality of their lives,” said the study’s principal investigator and lead author Eric C. Leuthardt, MD, the Shi Hui Huang Professor of Neurological Surgery at WashU Medicine and chief of the Division of Neurotechnology, who treats patients at Siteman Cancer Center, based at Barnes-Jewish Hospital and WashU Medicine. “This analysis identifies the factors that lead to the best outcomes. This critical new information will help us find opportunities for patients to benefit the most from this therapy.”
Eric C. Leuthardt, MD, Shi Hui Huang Professor of Neurological Surgery at WashU Medicine and chief of the Division of Neurotechnology
Precision Targeting and the Mechanics of LITT
When tumors are located deep within the brain or prove impossible to remove through conventional open procedures, neurosurgeons utilize LITT to destroy abnormal tissue without a full craniotomy. The procedure involves drilling a tiny hole in the skull and inserting a robotically controlled laser probe. Guided by intraoperative MRI technology that allows surgeons to observe tissue in real time, the probe follows a path designed to minimize damage to healthy brain tissue. Once positioned inside the tumor, the laser emits heat that kills surrounding cancer cells.
The surgical tool utilized in the study, NeuroBlate, was developed by Monteris Medical and cleared for marketing by the U.S. Food and Drug Administration in 2009.
For patients experiencing recurrent disease, the procedure offers a less punishing recovery than a second open operation. Patients are typically able to return home the day after the procedure.
Long-Term Milestones and Emerging Immunotherapy Combinations
Individual patient cases illustrate the expanding timeline of care. At Providence St. Jude Medical Center in Fullerton, California, 65-year-old Larry Anderson marked seven years since his initial stage 4 glioblastoma diagnosis. After surgeons initially removed his tumor in 2019, Anderson experienced a recurrence in 2022, at which point neurosurgeon Dr. Hector Ho treated the returning mass using LITT. Anderson subsequently underwent a second LITT procedure, and his recent scans remain clear.
That accuracy is super precise. So we are able to target a very small area in the brain that we think is abnormal,
Ho explained, noting that while malignant brain tumors inevitably carry a risk of recurrence, LITT provides a safe, highly controlled adjuvant option.
Beyond standalone ablation, researchers are exploring how LITT can act as a bridge to other advanced treatments. In a study of 45 patients with advanced recurrent high-grade astrocytoma published in Nature Communications, researchers observed dramatic survival improvements when laser interstitial thermal therapy was followed by Merck’s immunotherapy drug Keytruda. While drugs that harness T cells generally fail in brain tumors because the blood-brain barrier blocks their entry, earlier studies demonstrated that the heat produced by LITT temporarily disrupts the barrier for several weeks—giving activated T cells a critical window to reach and attack cancer cells.
