Disparities in clinical trial enrollment related to laser interstitial thermal therapy for central nervous system metastases.

OBJECTIVE: Laser interstitial thermal therapy (LITT) is a minimally invasive option for the management of a variety of intracranial pathologies, including radiographically progressive tumor following stereotactic radiosurgery. Although LITT has been increasingly accepted in recent years, little is known regarding selection and outcomes for patients of diverse backgrounds, particularly at centers specializing in central nervous system (CNS) metastases. METHODS: Patients receiving their index LITT treatment for brain metastasis at a single center from 2015 to 2023 were retrospectively reviewed. Patient demographics and geospatial data were used to compare differences in receipt of LITT by race or ethnicity, survival outcomes, and clinical trial enrollment. RESULTS: From 2015 to 2023, 137 patients harboring 146 target lesions presented for LITT. One hundred and six patients (77.3%) were non-Hispanic White (NHW); of Hispanic or non-White (HNW) patients, 25 (18.2%) were Black or African American, 5 (3.6%) were Asian, and 1 (0.7%) was Hispanic or Latino. Among HNW patients, women more frequently received LITT (p = 0.022), with skin cancers being a more frequent indication among NHW patients (P = 0.019). NHW patients traveled a median of 62.0 (6.2-1045.9) miles to receive LITT vs. 25.9 (1.31-238.3) miles for HNW patients (p = 0.001). There was parity in procedural outcomes across groups. In multivariate analyses, post-LITT overall survival was predicted by pre-LITT KPS (P = 0.0007) and recurrent tumor on biopsy (P = 0.0002), while probability of clinical trial enrollment was less among those of female sex (P = 0.049), HNW race/ethnicity (P = 0.041), or external referral status (P = 0.035). CONCLUSIONS: Patient sex, systemic disease histology, and distance from a treating center may differentially influence presentation for LITT according to underlying race/ethnicity. However, patients successfully treated in multidisciplinary CNS metastasis centers experience excellent post-procedural outcomes. Such centers should enact measures to ensure equitable clinical trial enrollment.

Duke Scholars

Author Andreas Seas  

Author James Emmett Herndon II Biostatistics & Bioinformatics, Division of Biostatistics

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