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RADT-03 PRE-OPERATIVE SINGLE FRACTION VERSUS FRACTIONATED STEREOTACTIC RADIOTHERAPY: A SINGLE-INSTITUTION ANALYSIS OF 299 RESECTED METASTASES

Abstract The treatment standard for patients with large or symptomatic brain metastases and limited intracranial disease is surgical resection followed by post-operative (post-op) stereotactic radiosurgery (SRS). The multicenter PROPS-BM cohort showed how pre-operative (pre-op) SRS may lead to a red...

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Published in:Neuro-oncology advances 2024-08, Vol.6 (Supplement_1), p.i29-i30
Main Authors: Perlow, Haley, Luu, Sydney, Reddy, Sohil, Bradshaw, Jared, Hennings, Sarah, Matsui, Jennifer, Klamer, Brett, Upadhyay, Rituraj, Oliver, Alexandria, McGregor, John, Lonser, Russell, Prevedello, Daniel, Elder, James, Wu, Kyle, Prabhu, Roshan, Zhu, Simeng, Singh, Raj, Beyer, Sasha, Grecula, John, Blakaj, Dukagjin, Thomas, Evan, Raval, Raju, Palmer, Joshua
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Language:English
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Summary:Abstract The treatment standard for patients with large or symptomatic brain metastases and limited intracranial disease is surgical resection followed by post-operative (post-op) stereotactic radiosurgery (SRS). The multicenter PROPS-BM cohort showed how pre-operative (pre-op) SRS may lead to a reduced incidence of radiation necrosis (RN), local failure (LF), and meningeal disease (MD) compared to historical controls. Fractionated treatments can deliver a higher biological effective dose and may reduce the incidence of LF and MD. We hypothesize that pre-op fractionated stereotactic radiation therapy (FSRT) will reduce the incidence rate of RN, MD, and LF when compared to patients who receive pre-op SRS. Patients who had surgical resection and pre-operative radiation to at least one brain metastasis at a single institution were retrospectively analyzed. Outcomes were evaluated on a per-lesion basis. The primary outcome was a composite endpoint defined by 1) LF, 2) MD, and/or 3) Grade 2 or higher (symptomatic) RN. 260 patients with 299 resected brain metastases were eligible for analysis. 64 metastases received SRS and 235 metastases received FSRT. 38 patients had multiple metastases resected pre-operatively. The median gross tumor volume was 4 ccs for SRS and 10 ccs for FSRT (p
ISSN:2632-2498
2632-2498
DOI:10.1093/noajnl/vdae090.099