A feasibility trial of delayed resection for brain metastases following pre-operative stereotactic radiosurgery
Journal Title
Journal of Neuro-Oncology
Publication Type
May 26
Abstract
PURPOSE: Pre-operative stereotactic radiosurgery (SRS) for brain metastases (BrM), an emerging alternative to post-operative SRS, is typically performed 1-2 days before resection. However, a longer period of the irradiated tumour in situ may confer anti-tumour immunological benefits. We conducted the first clinical trial to evaluate the feasibility of planned delayed resection after pre-operative SRS. METHODS: In this single-arm trial, patients with suspected BrM suitable for pre-operative SRS and surgery were eligible. The primary endpoint was feasibility of resection 7-21 days after SRS, with a pre-defined feasibility threshold of 66% receiving this. Secondary endpoints included 6-month adverse events (AE) and local control (LC) rates. Tumour volume change was assessed from SRS- and neurosurgery-planning MRI's. RESULT: 78 patients were screened and the target accrual of 15 patients was met. Common reasons for pre-operative SRS ineligibility were lack of existing cancer diagnosis (44%) and tumour size/peri-tumoural oedema (18%). Two patients declined resection after SRS. The median SRS-to-surgery interval was 8 days (range 0-15). Nine tumours in 8 patients (56%) received delayed resection. Reasons for earlier resection were predominantly non-medical. There were no Grade > 2 AE. The 6-month BrM LC was 100%. At a median follow-up of 13.8 months, the only BrM local failure after SRS and resection occurred with a 0-day SRS-to-surgery interval. No histopathological diagnosis issues were encountered with delayed resection. An increased SRS-to-surgery interval correlated with greater tumour shrinkage. CONCLUSIONS: The pre-defined feasibility threshold for delayed resection was not met, but more than half of patients received delayed resection without safety concerns. TRIAL REGISTRATION NUMBER: ACTRN12622001372774 (Registered 26/10/2022).
Publisher
Springer
Keywords
Brain metastases; Neuro-oncology; Neurosurgery; Pre-operative SRS; Radiation therapy; Stereotactic radiosurgery
Research Division(s)
Personalised Oncology
PubMed ID
40419819
Open Access at Publisher's Site
https://doi.org/10.1007/s11060-025-05081-2
Terms of Use/Rights Notice
Refer to copyright notice on published article.


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