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Preoperative Fractionated Stereotactic Radiosurgery for Brain Metastases: A Prospective Pilot Study at a Single
Alexander Marwaha1, Matthew J Shepard2, Yun Liang3
1Division of Radiation Oncology, Allegheny Health Network Cancer Institute, Pittsburgh, Pennsylvania.
Advances in Radiation Oncology
|January 8, 2026
Summary
Preoperative stereotactic radiosurgery (SRS) for brain metastases shows high local control and low rates of leptomeningeal disease (LMD) and radiation necrosis. This approach appears safe and effective, warranting further investigation in phase 3 trials.
Area of Science:
- Neurosurgery
- Radiation Oncology
- Oncology
Background:
- Brain metastases are common in advanced cancers.
- Traditional treatment involves surgery followed by stereotactic radiosurgery (SRS).
- Preoperative SRS is being explored to reduce leptomeningeal disease (LMD) and radiation necrosis.
Purpose of the Study:
- To investigate the safety and efficacy of 3-fraction preoperative SRS using Gamma Knife (GK) Icon.
- To evaluate outcomes including local control, distant brain failure, LMD, and radiation necrosis.
Main Methods:
- Prospective pilot study of patients with resectable brain metastases.
- Treatment with fractionated SRS (24-27 Gy in 3 fractions) followed by surgical resection within 2 weeks.
- Follow-up with MRI to assess local control, distant brain failure, LMD, and WBRT delivery.
Main Results:
- 95% 1-year local control rate in 20 patients treated preoperatively.
- 38% rate of distant brain failure at 6 and 12 months.
- Low rates of LMD (9.6%) and no recorded radionecrosis; 2 patients experienced short-term toxicity.
Conclusions:
- Fractionated preoperative SRS is safe and effective for brain metastases.
- High local control rates and low rates of LMD and radionecrosis observed.
- Phase 3 studies comparing preoperative vs. postoperative SRS are needed to optimize treatment sequencing.
