Stereotactic Radiosurgery to Prevent Local Recurrence of Brain Metastasis After Surgery: Neoadjuvant Versus Adjuvant

McCutcheon, Ian E.

doi:10.1007/978-3-030-69217-9_9

Cited by 4 publications

(3 citation statements)

References 71 publications

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“…Owing to the adverse events related to surgery, namely brain tissue manipulation with injury to the functional cortex and white matter tracts, and WBRT, namely neurotoxicity with neurocognitive impairment, SRS gained increasing interest as stand-alone or adjunct therapy for 1–3 BMs [ 50 , 51 , 52 ]. As large BMs (>3 cm) causing intracranial hypertension with neurological deficits requiring surgery, adjuvant SRS to the postoperative cavity has been largely investigated, with 1-year LC rates ranging 70–90% and variable OS achieved across several retrospective cohorts [ 53 ]. Two randomized trials confirmed that postoperative SRS correlated with higher LC rates but also superior risks of LM compared to surgery alone [ 9 ], and with lower neurocognitive deficits but also inferior distant intracranial control compared to postoperative WBRT [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

“…This was confirmed by the 20% dose reduction implemented across all included studies [ 27 , 28 ]. NaSRT is also expected to reduce the risk of post-surgery tumor spillage and LM, especially with piecemeal resection, by pre-treating cancer cells fated for intraoperative transposition and seeding with the CSF [ 29 , 53 ]. Despite the envisioned advantages, potential pitfalls of NaSRT approaches should also be noted, namely the lack of histological confirmation before starting radiation protocols.…”

Section: Discussionmentioning

confidence: 99%

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Neoadjuvant Stereotactic Radiotherapy for Brain Metastases: Systematic Review and Meta-Analysis of the Literature and Ongoing Clinical Trials

Palmisciano

Ferini²,

Khan

et al. 2022

Cancers

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Background: Brain metastases (BMs) carry a high morbidity and mortality burden. Neoadjuvant stereotactic radiotherapy (NaSRT) has shown promising results. We systematically reviewed the literature on NaSRT for BMs. Methods: PubMed, EMBASE, Scopus, Web-of-Science, Cochrane, and ClinicalTrial.gov were searched following the PRISMA guidelines to include studies and ongoing trials reporting NaSRT for BMs. Indications, protocols, and outcomes were analyzed using indirect random-effect meta-analyses. Results: We included 7 studies comprising 460 patients with 483 BMs, and 13 ongoing trials. Most BMs originated from non-small lung cell carcinoma (41.4%), breast cancer (18.7%) and melanoma (43.6%). Most patients had single-BM (69.8%) located supratentorial (77.8%). Patients were eligible if they had histologically-proven primary tumors and ≤4 synchronous BMs candidate for non-urgent surgery and radiation. Patients with primary tumors clinically responsive to radiotherapy, prior brain radiation, and leptomeningeal metastases were deemed non-eligible. Median planning target volume was 9.9 cm3 (range, 2.9–57.1), and NaSRT was delivered in 1-fraction (90.9%), 5-fraction (4.8%), or 3-fraction (4.3%), with a median biological effective dose of 39.6 Gy10 (range, 35.7–60). Most patients received piecemeal (76.3%) and gross-total (94%) resection after a median of 1-day (range, 1–10) post-NaSRT. Median follow-up was 19.2-months (range, 1–41.3). Actuarial post-treatment rates were 4% (95%CI: 2–6%) for symptomatic radiation necrosis, 15% (95%CI: 12–18%) and 47% (95%CI: 42–52%) for local and distant recurrences, 6% (95%CI: 3–8%) for leptomeningeal metastases, 81% (95%CI: 75–87%) and 59% (95%CI: 54–63%) for 1-year local tumor control and overall survival. Conclusion: NaSRT is effective and safe for BMs. Ongoing trials will provide high-level evidence on long-term post-treatment outcomes, further compared to adjuvant stereotactic radiotherapy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Neoadjuvant Stereotactic Radiotherapy for Brain Metastases: Systematic Review and Meta-Analysis of the Literature and Ongoing Clinical Trials

Palmisciano

Ferini²,

Khan

et al. 2022

Cancers

View full text Add to dashboard Cite

show abstract

“…More recently, investigators have explored the role for neoadjuvant SRS in the treatment of oligometastatic disease. While no clinical trial to date has evaluated the efficacy of SRS in the neoadjuvant role ( 53 ), one combination prospective/retrospective study has suggested that it is safe and does not increase the risk of radiation necrosis or leptomeningeal spread of disease ( 54 ); further studies are currently underway ( 55 , 56 ).…”

Section: Treatmentmentioning

confidence: 99%

Review of Current Principles of the Diagnosis and Management of Brain Metastases

Brenner

Patel

2022

Front. Oncol.

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Brain metastases are the most common intracranial tumors and are increasing in incidence as overall cancer survival improves. Diagnosis of brain metastases involves both clinical examination and magnetic resonance imaging. Treatment may involve a combination of surgery, radiotherapy, and systemic medical therapy depending on the patient’s neurologic status, performance status, and overall oncologic burden. Advances in these domains have substantially impacted the management of brain metastases and improved performance status and survival for some patients. Indications for surgery have expanded with improved patient selection, imaging, and intraoperative monitoring. Robust evidence supports the use of whole brain radiotherapy and stereotactic radiosurgery, for both standalone and adjuvant indications, in almost all patients. Lastly, while systemic medical therapy has historically provided little benefit, modern immunotherapeutic agents have demonstrated promise. Current investigation seeks to determine the utility of neoadjuvant radiotherapy and laser interstitial thermal therapy, which have shown benefit in limited studies to date. This article provides a review of the epidemiology, pathology, diagnosis, and treatment of brain metastases and the corresponding supporting evidence.

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Efficacy of neoadjuvant stereotactic radiotherapy in brain metastases from solid cancer: a systematic review of literature and meta-analysis

Gagliardi,

De Domenico,

Snider

et al. 2023

Neurosurg Rev

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Stereotactic Radiosurgery to Prevent Local Recurrence of Brain Metastasis After Surgery: Neoadjuvant Versus Adjuvant

Cited by 4 publications

References 71 publications

Neoadjuvant Stereotactic Radiotherapy for Brain Metastases: Systematic Review and Meta-Analysis of the Literature and Ongoing Clinical Trials

Neoadjuvant Stereotactic Radiotherapy for Brain Metastases: Systematic Review and Meta-Analysis of the Literature and Ongoing Clinical Trials

Review of Current Principles of the Diagnosis and Management of Brain Metastases

Efficacy of neoadjuvant stereotactic radiotherapy in brain metastases from solid cancer: a systematic review of literature and meta-analysis

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