Single-Fraction Versus Fractionated Preoperative Radiosurgery for Resected Brain Metastases: A PROPS-BM International
Roshan S Prabhu1, Tobi Akinyelu2, 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
|September 17, 2023
Summary
Preoperative multifraction stereotactic radiosurgery (MF-SRS) for brain metastases (BM) significantly reduced local recurrence compared to single-fraction SRS (SF-SRS). No differences in toxicity or survival were observed, suggesting MF-SRS may be preferred for resected BM.
Area of Science:
- Neurosurgery
- Radiation Oncology
- Oncology
Background:
- Preoperative stereotactic radiosurgery (SRS) is an emerging treatment for resected brain metastases (BM).
- Most studies have focused on single-fraction SRS (SF-SRS), but multifraction SRS (MF-SRS) may offer different outcomes.
- This study compares preoperative SF-SRS and MF-SRS in a large international cohort.
Purpose of the Study:
- To compare the efficacy and toxicity of preoperative single-fraction SRS (SF-SRS) versus multifraction SRS (MF-SRS) for resected brain metastases (BM).
- To evaluate intracranial outcomes, including local recurrence, adverse radiation effects, and overall survival.
Main Methods:
- A large international multicenter cohort study included 404 patients with BM treated with preoperative SRS followed by resection.
- Patients received either SF-SRS (15 Gy in 1 fraction) or MF-SRS (24 Gy in 3 fractions).
- Propensity score matching (PSM) was used to analyze outcomes, comparing cavity local recurrence, meningeal disease, and overall survival.
Main Results:
- SF-SRS was used in 78.5% of cases and MF-SRS in 21.5%.
- Univariable and multivariable analyses, including PSM, showed significantly higher cavity local recurrence rates with SF-SRS compared to MF-SRS (2-year rates: 19.8% vs 3.3% in PSM).
- No significant differences were found in adverse radiation effects, meningeal disease, or overall survival between the SF-SRS and MF-SRS groups.
Conclusions:
- Preoperative MF-SRS is associated with a significantly reduced risk of cavity local recurrence after resection of brain metastases compared to SF-SRS.
- MF-SRS may be a preferred neoadjuvant radiation therapy option for resected BM.
- Further studies, including a phase 3 randomized trial, are needed to confirm these findings.
