NCTQ-05 Functional and Neurocognitive Outcomes After Mri-Guided Laser Interstitial Thermal Therapy for Brain Metastases: A Systematic Review and Meta-Analysis

Laser interstitial thermal therapy (LITT) is increasingly utilized as a minimally invasive option for treating brain metastases (BM) in patients with progressive or radiosurgery-refractory disease. However, the impact of LITT on functional status, neurological recovery, and patient-reported quality of life (QoL) remains unclear. This meta-analysis evaluates pooled outcomes for functional performance, neurological improvement, and QoL following LITT in patients with BM. A systematic search of PubMed/MEDLINE, Cochrane Library, and conference proceedings (ASCO, SNO, CNS) was conducted through March 2025. Studies reported post-treatment outcomes including Karnofsky Performance Status (KPS), neurological recovery, or validated QoL/cognitive tools. Pooled estimates were calculated using random-effects models with 95% confidence intervals (CIs). Heterogeneity was quantified using I². Six observational studies (N=204 patients) met inclusion criteria. Study designs included prospective cohorts (n=3), case series (n=2), and one retrospective cohort. The median age was 59.3 years (IQR: 56.2–63.3). KPS was reported in all studies; QoL tools (FACT-Br, EQ-5D) were used in three studies, and cognitive assessments (HVLT-R) in two studies. Meta-analysis of five studies (n=198) demonstrated a non-significant change in KPS after LITT: Mean difference = –4.68 (95% CI: –14.31 to +4.96; p=0.341; I²=0%). Across five studies (n=89), the pooled proportion of patients with neurological improvement—defined by symptom resolution, steroid tapering, or cognitive gain—was: 63% (95% CI: 45–80%; p<0.001; I²=67.7%). Two studies (n=72) reporting patient-reported QoL and cognitive scores showed no significant change: Mean difference = –2.80 (95% CI: –10.32 to +4.73; p=0.467; I²=0%). MRI-guided LITT appears to preserve functional status and yields neurological improvement in most patients with BM, without significant detriment to QoL or cognition. While results are promising, the evidence is limited to observational data, and prospective trials evaluating patient-centered outcomes are warranted.