Postoperative Cavity Stereotactic Radiosurgery for Brain Metastases

Area of Science:

• Neurosurgery
• Radiation Oncology
• Oncology

Background:

• Stereotactic radiosurgery (SRS) is an alternative to whole brain radiation therapy (WBRT) for brain metastases post-resection.
• SRS offers improved local control rates with potentially reduced neurotoxicity compared to WBRT.
• Established risk factors for local recurrence include subtotal resection, large volumes, low doses, and delayed SRS.

Purpose of the Study:

• To review the current utilization and efficacy of SRS in the management of brain metastases after surgical resection.
• To highlight optimal planning strategies for postoperative SRS to improve outcomes.
• To discuss emerging techniques like multifraction or preoperative SRS for reducing complications.

Main Methods:

• Review of recent literature on tumor bed SRS for brain metastases.
• Analysis of factors influencing local control and recurrence risk.
• Discussion of expert consensus on SRS planning and emerging techniques.

Main Results:

• SRS demonstrates favorable local control rates compared to WBRT.
• A 2 mm margin around the resection cavity improves local control.
• Key planning strategies include pre-operative MRI fusion, surgical tract contouring, and target expansion for microscopic disease.

Conclusions:

• Postoperative SRS is an effective treatment for brain metastases, with specific planning strategies enhancing outcomes.
• Minimizing radiation-induced injury and leptomeningeal dissemination is achievable through meticulous SRS planning.
• Multifraction or preoperative SRS show promise in reducing radiation necrosis and leptomeningeal disease, warranting further clinical trials.