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

Udovicich, C; Ng, SP; Tange, D; Bailey, N; Haghighi, N

Author(s): Udovicich, C; Ng, SP; Tange, D; Bailey, N; Haghighi, N;
Details: Publication Year 2022-04,Volume 22,Issue #4,Page 208-214
Journal Title: Operative Neurosurgery
Publication Type: Research article
Abstract: BACKGROUND: 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. OBJECTIVE: To report the local control (LC) and LMD rates in patients undergoing NaSRS. METHODS: 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. RESULTS: 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. CONCLUSION: 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.
Keywords: Adult; Aged; Aged, 80 and over; *Brain Neoplasms/pathology/radiotherapy/surgery; *Carcinoma, Non-Small-Cell Lung/secondary/surgery; Humans; *Lung Neoplasms/radiotherapy/surgery; *Meningeal Neoplasms/surgery; Middle Aged; Neoadjuvant Therapy/adverse effects; *Radiosurgery/adverse effects; Retrospective Studies; Treatment Outcome
Department(s): Radiation Oncology; Surgical Oncology
PubMed ID: 35234410
Publisher's Version: https://doi.org/10.1227/ONS.0000000000000101
Terms of Use/Rights Notice: Refer to copyright notice on published article.

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Last Modified: 2025-04-24 07:52:36