Preoperative stereotactic radiosurgery for brain metastases

David M. Routman, Elizabeth Yan, Sujay Vora, Jennifer Peterson, Anita Mahajan, Kaisorn L. Chaichana, Nadia N Laack, Paul D. Brown, Ian F Parney, Terence Burns, Daniel Trifiletti

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Stereotactic radiosurgery (SRS) is increasingly utilized to treat the resection cavity following resection of brain metastases and recent randomized trials have confirmed postoperative SRS as a standard of care. Postoperative SRS for resected brain metastases improves local control compared to observation, while also preserving neurocognitive function in comparison to whole brain radiation therapy (WBRT). However, even with surgery and SRS, rates of local recurrence at 1 year may be as high as 40%, especially for larger cavities, and there is also a known risk of leptomeningeal disease after surgery. Additional treatment strategies are needed to improve control while maintaining or decreasing the toxicity profile associated with treatment. Preoperative SRS is discussed here as one such approach. Preoperative SRS allows for contouring of an intact metastasis, as opposed to an irregularly shaped surgical cavity in the post-op setting. Delivering SRS prior to surgery may also allow for a “sterilizing” effect, with the potential to increase tumor control by decreasing intra-operative seeding of viable tumor cells beyond the treated cavity, and decreasing risk of leptomeningeal disease. Because there is no need to treat brain surrounding tumor in the preoperative setting, and since the majority of the high dose volume can then be resected at surgery, the rate of symptomatic radiation necrosis may also be reduced with preoperative SRS. In this mini review, we explore the potential benefits and risks of preoperative vs. postoperative SRS for brain metastases as well as the existing literature to date, including published outcomes with preoperative SRS.

Original languageEnglish (US)
Article number201800959
JournalFrontiers in Neurology
Volume9
Issue numberNOV
DOIs
StatePublished - Nov 13 2018

Fingerprint

Radiosurgery
Neoplasm Metastasis
Brain
Standard of Care
Brain Neoplasms
Neoplasms
Necrosis
Radiotherapy
Observation
Radiation
Recurrence

Keywords

  • Brain metastases
  • Leptomeningeal disease
  • Local recurrence
  • Neoadjuvant
  • Postoperative
  • Preoperative
  • Radionecrosis
  • Stereotactic radiosurgery (SRS)

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

Cite this

Routman, D. M., Yan, E., Vora, S., Peterson, J., Mahajan, A., Chaichana, K. L., ... Trifiletti, D. (2018). Preoperative stereotactic radiosurgery for brain metastases. Frontiers in Neurology, 9(NOV), [201800959]. https://doi.org/10.3389/fneur.2018.00959

Preoperative stereotactic radiosurgery for brain metastases. / Routman, David M.; Yan, Elizabeth; Vora, Sujay; Peterson, Jennifer; Mahajan, Anita; Chaichana, Kaisorn L.; Laack, Nadia N; Brown, Paul D.; Parney, Ian F; Burns, Terence; Trifiletti, Daniel.

In: Frontiers in Neurology, Vol. 9, No. NOV, 201800959, 13.11.2018.

Research output: Contribution to journalArticle

Routman, DM, Yan, E, Vora, S, Peterson, J, Mahajan, A, Chaichana, KL, Laack, NN, Brown, PD, Parney, IF, Burns, T & Trifiletti, D 2018, 'Preoperative stereotactic radiosurgery for brain metastases', Frontiers in Neurology, vol. 9, no. NOV, 201800959. https://doi.org/10.3389/fneur.2018.00959
Routman DM, Yan E, Vora S, Peterson J, Mahajan A, Chaichana KL et al. Preoperative stereotactic radiosurgery for brain metastases. Frontiers in Neurology. 2018 Nov 13;9(NOV). 201800959. https://doi.org/10.3389/fneur.2018.00959
Routman, David M. ; Yan, Elizabeth ; Vora, Sujay ; Peterson, Jennifer ; Mahajan, Anita ; Chaichana, Kaisorn L. ; Laack, Nadia N ; Brown, Paul D. ; Parney, Ian F ; Burns, Terence ; Trifiletti, Daniel. / Preoperative stereotactic radiosurgery for brain metastases. In: Frontiers in Neurology. 2018 ; Vol. 9, No. NOV.
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