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Preoperative Radiosurgery for Resected Brain Metastases: The PROPS-BM Multicenter Cohort Study.

Roshan S Prabhu1, Reshika Dhakal2, Zachary K Vaslow3

  • 1Levine Cancer Institute, Atrium Health, Charlotte, North Carolina; Southeast Radiation Oncology Group, Charlotte, North Carolina.

International Journal of Radiation Oncology, Biology, Physics
|May 31, 2021
PubMed
Summary

Preoperative radiosurgery (SRS) for brain metastases (BM) is effective, showing low rates of adverse radiation effects (ARE) and leptomeningeal disease (LMD) relapse. This large multicenter study confirms its feasibility and safety before surgery.

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Area of Science:

  • Neurosurgery
  • Radiation Oncology
  • Oncology

Background:

  • Preoperative radiosurgery (SRS) for brain metastases (BM) is an emerging treatment modality.
  • Previous studies were limited by small sample sizes and single-institution designs.
  • The PROPS-BM study aimed to evaluate preoperative SRS outcomes in a large multicenter cohort.

Purpose of the Study:

  • To evaluate the efficacy and safety of preoperative SRS for BM.
  • To identify prognostic factors for local recurrence (LR) and leptomeningeal disease (LMD).
  • To assess the risk of postoperative surgical complications.

Main Methods:

  • A multicenter cohort of 242 patients with BM from solid cancers treated with preoperative SRS and planned resection.
  • Data collected on demographics, tumor characteristics, SRS parameters, surgical outcomes, and recurrence rates.
  • Radiographic meningeal disease (MD) categorized as nodular or classical (cLMD).

Main Results:

  • Local recurrence (LR) rates at 1 and 2 years were 15% and 17.9%, respectively.
  • Subtotal resection (STR) was a strong predictor of LR (HR, 9.1; P < .001).
  • Rates of MD were 6.1% (1 year) and 7.6% (2 years); rates of any grade ARE were 4.7% (1 year) and 6.8% (2 years).
  • Median overall survival (OS) was 16.9 months; 2-year OS rate was 38.4%.
  • 4.1% of patients experienced grade ≥3 postoperative surgical complications.

Conclusions:

  • Preoperative SRS is a feasible and safe treatment for BM, with favorable outcomes regarding LMD and ARE.
  • Subtotal resection is associated with significantly worse cavity LR.
  • A randomized trial comparing preoperative and postoperative SRS is warranted.