From Postoperative to Preoperative: A Case Series of Hypofractionated and Single-Fraction Neoadjuvant Stereotactic Radiosurgery for Brain Metastases.

Publication date: Apr 01, 2022

Postoperative stereotactic radiosurgery after resection of brain metastases is currently the standard of care. However, rates of leptomeningeal disease (LMD) after postoperative stereotactic radiosurgery have been reported to be >30%. Neoadjuvant stereotactic radiosurgery (NaSRS) has been proposed as an alternative treatment approach to decrease this risk. To report the local control (LC) and LMD rates in patients undergoing NaSRS. Our retrospective multicenter case series included consecutive patients planned for SRS followed by resection of intracranial lesions with a confirmed primary malignancy. Concurrent SRS alone to other intracranial lesions was permitted. Exclusion criteria included previous local treatment to that particular lesion and Eastern Cooperative Oncology Group performance status ≥3. Outcomes reported included LC, distant intracranial control (DC), overall survival, LMD, and radionecrosis (RN) rates. Overall, 28 patients with 29 lesions were eligible for analysis. The median follow-up was 12. 8 months. The mean age was 62. 5 (range 43-80) years, and 55% were Eastern Cooperative Oncology Group performance status 0 to 1. The most common primary malignancies included non-small cell lung cancer (43%) and melanoma (32%). Hypofractionated SRS was used in 62. 1%. The 12-month LC and LMD rates were 91. 3% and 4. 0%, respectively. The 12-month RN, DC, and overall survival rates were 5. 0%, 51. 5%, and 60. 1%, respectively. Compared with postoperative SRS, our study suggests that NaSRS leads to comparable local control with a decreased risk of LMD and RN. This is the first NaSRS series with a majority of patients treated with fractionated SRS. NaSRS is a promising approach for appropriate patients where surgical resection is a component of local therapy.

Concepts Keywords
Hagerstown Biopsy
Month Computer-assisted surgery
Postoperative Stereotactic surgery
Radiosurgery Radiosurgery
Stereotactic Brain metastasis
Lung cancer
Radiobiology
Brain tumor
Neurosurgery
Clinical medicine
Medical specialties
Medicine

Semantics

Type Source Name
pathway KEGG Melanoma
disease MESH melanoma
pathway KEGG Non-small cell lung cancer
disease MESH non-small cell lung cancer
disease MESH malignancy
disease MESH Brain Metastases

Original Article

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