Preoperative Radiosurgery in Management of Brain Metastases
Erkan Topkan *
Department of Radiation Oncology, Baskent University Medical Faculty, Adana, Turkey.
Ahmet Kucuk
Mersin City Education and Research Hospital, Radiation Oncology Clinics, Mersin, Turkey.
Sukran Senyurek
Department of Radiation Oncology, School of Medicine, Koc University, Istanbul, Turkey.
Duygu Sezen
Department of Radiation Oncology, School of Medicine, Koc University, Istanbul, Turkey.
Nulifer Kilic Durankus
Department of Radiation Oncology, School of Medicine, Koc University, Istanbul, Turkey.
Eyub Yasar Akdemir
Department of Radiation Oncology, School of Medicine, Koc University, Istanbul, Turkey.
Esma Didem Ikiz
Department of Radiation Oncology, Kahramanmaras Necip Fazil City Hospital, Kahramanmaras, Turkey.
Yasemin Bolukbasi
Department of Radiation Oncology, School of Medicine, Koc University, Istanbul, Turkey.
Berrin Pehlivan
Department of Radiation Oncology, Bahcesehir University, Istanbul, Turkey.
Ugur Selek
Department of Radiation Oncology, School of Medicine, Koc University, Istanbul, Turkey.
*Author to whom correspondence should be addressed.
Abstract
Brain metastases (BMs), the most frequent intracranial tumors, are diagnosed in approximately 30% of all adult patients over the span of planned treatment against a broad spectrum of solid cancers. The prognosis of patients presenting with BM is bleak with an expected median OS of only 4-7 months. However, some particular patients’ groups may enjoy longer survival durations with effective systemic and local therapies. At present, the feasible alternatives for active management of BMs typically include the whole-brain radiotherapy (WBRT), surgery, definitive SRS, postoperative SRS, systemic chemotherapy, targeted therapies, and their combination variants. Considering the local treatment, the severe neurotoxic effects of WBRT, and the increased risk for radionecrosis and leptomeningeal dissemination after postoperative SRS and together with the ineligibility of certain patients during the postoperative period prompted the energetic quest of alternative treatment strategies for such patients. In this respect, the novel preoperative SRS (PO-SRS) was proposed to provide at least equivalent local control rates with lesser radionecrosis and leptomeningeal dissemination risk. Respecting the scarcity of related literature, the present review aimed to meticulously detail theplausible rationale and accessible evidence for the novel PO-SRS in the management of patients presenting with BMs.
Keywords: Brain metastasis, postoperative stereotactic radiosurgery, local control, survival, complications.