Neoadjuvant Stereotactic Radiosurgery Before Surgical Resection of Cerebral Metastases

• Published in: World neurosurgery 2018-12, Vol.120, p.e480-e487
• Main Authors: Patel, Ankur R., Nedzi, Lucien, Lau, Steven, Barnett, Samuel L., Mickey, Bruce E., Moore, William, Bindal, Shivani, Wardak, Zabi, Dan, Tu, Timmerman, Robert, Patel, Toral R.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Brain Neoplasms - secondary; Brain Neoplasms - surgery; Brain Neoplasms - therapy; Cerebral metastases; Female; Follow-Up Studies; Humans; Kaplan-Meier Estimate; Leptomeningeal disease; Male; Middle Aged; Neoadjuvant; Neoadjuvant Therapy - adverse effects; Neoadjuvant Therapy - methods; Patient Safety; Radiosurgery - adverse effects; Radiosurgery - methods; Retrospective Studies; Stereotactic radiosurgery; Surgical resection; Survival Analysis; Tumor Burden
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2018.08.107

Stereotactic radiosurgery (SRS) has redefined the treatment paradigm for cerebral metastases. The benefits of SRS after surgical resection of a metastatic brain tumor have been well-defined. However, it is unclear whether preoperative SRS can improve the outcomes in select patients. The present study examined the safety and efficacy of preoperative neoadjuvant SRS (NaSRS) for the treatment of cerebral metastases. We performed a retrospective review of 12 patients treated at The University of Texas Southwestern Medical Center. All patients underwent NaSRS, followed by surgical resection of a cerebral metastasis, from 2011 to 2015. Recurrence and overall survival were characterized using Kaplan-Meier and log-rank analyses. The mean age was 57.5 years (range, 39–69). The median follow-up period was 13 months (range, 1–22.6). The median maximum tumor diameter was 3.66 cm (range, 2.19–4.85). The 6- and 12-month local control rates were 81.8% and 49.1%, respectively. The distant disease control rates were 72.7% and 14.5% at 6 and 12 months, respectively. Overall survival was 83.3% and 74.1% at 6 and 12 months, respectively. Two patients developed leptomeningeal disease at a mean of 11.3 months. A trend toward increased local failure was seen with larger tumor volumes and diameters (P = 0.06). NaSRS is a promising new approach for the treatment of select cerebral metastases that require surgical intervention. The approach is safe and effective at achieving local control. Further randomized studies with larger patient cohorts are necessary to determine whether the long-term outcomes are improved. •NaSRS is safe.•NaSRS results in good local control.•Posterior fossa metastases might preferentially benefit from this approach.•Randomized trials comparing pre- and postoperative radiosurgery are needed.