Same-Session LITT Plus Biopsy in Unresectable Glioblastoma

Key Takeaways

• Longer median survival was observed in the biopsy-plus-LITT group than in the biopsy-alone group.
• Mean 5-month QLQ-C30 summary scores were numerically close at 81 versus 77.
• The trial stopped early after funding retraction and slow enrollment, and the authors said small sample size and baseline imbalances prevented definitive conclusions about effectiveness or cost-effectiveness.

The EMITT trial randomized adults with unresectable glioblastoma to biopsy alone or biopsy with same-session MRI-guided laser interstitial thermal therapy followed by standard care. In this multicenter comparison of tumors considered unresectable at study entry, median survival was 7.8 months in the intervention group and 4.8 months in controls. The trial ended early following funding retraction in the setting of slow patient inclusion. The findings provide an early randomized signal rather than a definitive comparative result.

EMITT was a non-blinded multicenter randomized controlled trial conducted across seven Dutch neurosurgical hospitals. Investigators enrolled adult patients with unresectable glioblastoma and used 1:1 assignment to the two procedural strategies. One group underwent biopsy alone, while the other received biopsy with same-session LITT followed by standard care. Between April 19, 2022, and March 19, 2024, 29 patients entered the study, and 3 were excluded after randomization. That left 26 patients for intention-to-treat analysis, including 14 controls and 12 intervention patients, before funding was retracted as enrollment slowed.

The prespecified primary outcomes were overall survival and health-related quality of life measured 5 months after randomization. At the 5-month assessment, mean QLQ-C30 summary scores were 77 in controls and 81 in the intervention group. Variability was the same in both groups, with an SD of 11 for the cancer-specific summary measure at that timepoint. Survival estimates also had broad confidence bounds, with the reported median in controls spanning 3.4 months to not estimable. In the intervention group, the corresponding interval extended from 2.58 months to not estimable, and minimum follow-up lasted at least 18 months or until death.

The authors kept their interpretation narrow because early stopping left the randomized dataset small. They also noted baseline imbalances between groups, which limited interpretation of the observed differences in survival and quality-of-life measures. They did not draw definitive conclusions about effectiveness or cost-effectiveness from these trial data. The survival and quality-of-life patterns therefore remained exploratory in this small randomized comparison.