A feasibility trial of delayed resection for brain metastases following pre-operative stereotactic radiosurgery
- Author(s)
- Schröder, C; Haghighi, N; Phillips, C; Udovicich, C; Li, MP; Drummond, K; Dimou, J; Davidson, AS; Sia, J;
- 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
- Publisher's Version
- https://doi.org/10.1007/s11060-025-05081-2
- 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.
Creation Date: 2025-05-29 02:03:18
Last Modified: 2025-05-29 02:08:05