Despite multimodal therapy, glioblastomas invariably recur. In focal recurrent glioblastoma IDH-wildtype (rGBM), local therapy options include laser interstitial thermal therapy (LITT) and stereotactic radiosurgery (SRS), but their relative utilities are unknown. The goal of this study is to compare the efficacy of these two treatment modalities in a homogeneous rGBM population. We conducted a retrospective study of patients undergoing surgical procedures for rGBM between 2010 and 2025. All patients underwent either LITT or SRS at first recurrence. Survival outcomes were assessed with univariable log-rank tests and multivariate Cox regression models. A propensity-score matching (PSM) was performed to address confounders. 57 patients were identified; of these, 10 underwent LITT, and 47 underwent SRS. There was no difference in post-recurrence survival (PRS) between groups (11.5 months vs. 13.4 months, p = 0.824). There were no surgical complications in the LITT cohort. In the SRS cohort, there were two symptomatic radiation necrosis cases (0% vs. 4.3%, p = 1.000). Contrast-enhancing tumor volume at recurrence was larger in the LITT cohort (8.49 cm3 vs. 1.91 cm3, p = 0.007). To address this difference, we performed a PSM of two cohorts with 7 patients each. This PSM analysis also revealed no significant difference in survival outcomes. Within the limitations of a relatively small sample size, no statistically significant differences in outcomes were observed between LITT and SRS for the treatment of small, focal rGBM. Both modalities remain viable salvage options for small focal rGBM. Larger, multi-institutional studies are warranted.
Bindal et al. (Fri,) studied this question.