The Emerging Paradigm of Preoperative Stereotactic Radiosurgery for Resectable Brain Metastases
Menée auprès de 404 patients présentant des métastases cérébrales ayant pour origine un cancer solide (âge médian : 60,6 ans), cette étude évalue l'efficacité, du point de vue de la récidive locale, d'une radiochirurgie préopératoire puis analyse les facteurs pronostiques associés
In the treatment of metastatic brain disease, the efficacy of stereotactic radiosurgery (SRS) as an effective cognition-sparing alternative to whole-brain radiotherapy (WBRT) has been well-established, largely in part to the level 1 evidence provided by Chang et al that supports the initial treatment of brain metastases with the combination of SRS and close monitoring rather than with WBRT. For metastatic brain disease that is amenable to operative resection (1-4 brain metastases total with at least 1 lesion producing a significant mass effect and/or ≥2 cm in maximum diameter), Mahajan et al provided level 1 evidence that SRS (performed in this trial as single-fraction gamma knife SRS) is associated with reduced 1-year resection cavity local recurrence from 57% to 28% for patients with 1 to 3 resected brain metastases. Brown et al provided level 1 evidence that suggested that for patients with 1 resected brain metastasis and a resection cavity less than 5 cm, SRS is significantly less toxic than WBRT to cognition, with this reduced toxic effect not compromising overall survival.
JAMA Oncology 2023