Spine laser interstitial thermal therapy

The National Cancer Institute awarded Dartmouth-Hitchcock Clinic $633,819 on September 1, 2026, under the Cancer Detection and Diagnosis Research program (CFDA 93.394) to develop and validate advanced imaging techniques for laser interstitial thermal therapy (LITT) in the treatment of spinal metastases.

The project addresses two critical technical barriers limiting clinical adoption of LITT for spinal tumors: inaccuracies in MRI thermometry caused by motion artifacts from respiration and cardiac pulsation, and difficulty in precise laser fiber placement due to limited soft tissue contrast in conventional low-dose CT image guidance systems. Dartmouth-Hitchcock will develop MRI thermometry methods to compensate for motion artifacts and improve real-time temperature monitoring during LITT, and will create a novel MRI-based image guidance system to enable accurate laser fiber placement. The research team will validate these advancements using motion phantoms and a porcine model of spinal metastases.

Performance occurs in Lebanon, New Hampshire, with the project period running through August 31, 2031. The award is structured as a Project Grant, the standard NIH assistance type for individual research projects evaluated on scientific merit and program relevance.

Abstract

Spinal metastases are a common and devastating complication of metastatic cancer, affecting 40% of patients with aggressive cancer and leading to severe pain, neurological impairment, and diminished quality of life. The current standard of care is surgical resection followed by radiation therapy. While this treatment improves survival and function, IT is invasive, associated with prolonged hospital admission, blood loss, pain, wound complications, and disruption of needed systemic therapy and/or anticoagulation. There is a critical need for minimally invasive alternatives to reduce the morbidity of spinal tumor treatment. Laser interstitial thermal therapy (litt) is a promising minimally invasive alternative, offering tumor control comparable to conventional surgery but with reduced blood loss, shorter hospitalization, and faster recovery. Despite its potential, the widespread clinical adoption of litt for spinal metastases remains extremely limited, primarily due to two key technical challenges: (1) inaccuracies in MRI thermometry due to motion artifacts from respiration and cardiac pulsation, and (2) difficulty in precise laser fiber placement due to limited soft tissue contrast in commercially available low-dose CT based intraoperative image guidance systems. These limitations hinder the accuracy and safety of litt, preventing its broad clinical implementation. To address these barriers, we will develop and validate MRI thermometry to compensate for motion artifacts and improve the accuracy of real-time temperature monitoring during litt. Additionally, we will develop a novel MRI-based image guidance system to enable accurate and efficient laser fiber placement, overcoming the limitations of conventional low-dose CT navigation. These advancements will be rigorously tested using motion phantoms and a novel porcine model of spinal metastases, allowing for pre-clinical validation in a clinically relevant setting. Only a large animal model can recapitulate the non-uniform cardiac and respiratory motion artifact as well as the tissue heterogeneity of the human spine allowing for clinical translation of motion compensated thermography. This work will be a collaboration between dartmouth and clearpoint neuro, a leading developer of a laser therapy system to necrotize or coagulate soft tissue through interstitial irradiation or thermal therapy under magnetic resonance imaging (MRI) guidance. Clearpoint will provide its FDA-approved prism TM system and integrate MRI-based thermometry for spine, and will work closely with dartmouth to adapt these technologies for spine litt applications. The partnership will ensure that technical innovations developed in this project are rapidly translated into commercially viable solutions, facilitating widespread clinical adoption. Finally, we will translate these findings into a clinical trial to assess the feasibility, accuracy, and safety of MRI-guided litt for spinal tumors. Upon completion, we will establish litt as a minimally invasive, image-guided alternative to open surgery for spine metastases, broaden its clinical adoption through our industry partnership, and ultimately transform the standard of care for spinal metastases treatment with improved patient outcomes and quality of life.