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Publications

Journal Article Review Ppublish

PubMed: 39358195 DOI: 10.1016/j.canrad.2024.07.006

Preoperative stereotactic radiotherapy for the management of brain metastases.

Cancer Radiother 28(6-7):534-537

Authors: Julian Biau, Florent Guillemin, Angeline Ginzac, Julie Villa, Gilles Truc, Delphine Antoni, Clara Le Fèvre, François Thillays

Affiliations

  • Radiation Oncology Department, centre Jean-Perrin, Clermont-Ferrand, France; U1240 IMoST, Inserm, université Clermont-Auvergne, Clermont-Ferrand, France.
  • Radiation Oncology Department, centre Jean-Perrin, Clermont-Ferrand, France.
  • U1240 IMoST, Inserm, université Clermont-Auvergne, Clermont-Ferrand, France; Clinical Research and Innovation Department, centre Jean-Perrin, Clermont-Ferrand, France; UMR 501, Clinical Investigation Centre, Clermont-Ferrand, France.
  • Radiation Oncology Department, CHU de Grenoble, Grenoble, France.
  • Radiation Oncology Department, centre Georges-François-Leclerc, Dijon, France.
  • Radiation Oncology Department, Institut de cancérologie Strasbourg Europe, Strasbourg, France.
  • Radiation Oncology Department, Institut de cancérologie de l'Ouest, Nantes, France.

Abstract

Traditionally, postoperative whole-brain radiation therapy (WBRT) has been used for resected brain metastases, reducing local and intracerebral relapses. However, WBRT is associated with cognitive deterioration. Postoperative stereotactic radiotherapy (SRT) has emerged due to its neurocognitive preservation benefits. Despite its advantages, postoperative SRT has several drawbacks, including difficulties in target volume delineation, increased risk of radionecrosis (RN) and leptomeningeal disease (LMD), and prolonged treatment duration. Preoperative SRT has been proposed as a potential alternative, offering promising results in retrospective studies. Retrospective studies have suggested that preoperative SRT could achieve high local control rates with fewer LMD and RN rates compared to postoperative SRT. However, preoperative SRT is primarily based on retrospective data, and no phase 2/3 trials have been published to date. Ongoing clinical trials are expected to provide further insights into the efficacy and safety of preoperative SRT, addressing key questions regarding fractionation, dose, and timing relative to surgery.

MeSH

Radiotherapy, Brain, Retrospective Studies, Neoplasm Metastasis, Therapeutics