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Neurooncol Adv
Neurooncol Adv
noa
Neuro-Oncology Advances
2632-2498
Oxford University Press US

10.1093/noajnl/vdae090.099
vdae090.099
Final Category: Radiation Therapy Advances
AcademicSubjects/MED00300
AcademicSubjects/MED00310
RADT-03 PRE-OPERATIVE SINGLE FRACTION VERSUS FRACTIONATED STEREOTACTIC RADIOTHERAPY: A SINGLE-INSTITUTION ANALYSIS OF 299 RESECTED METASTASES
Perlow Haley Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA

Luu Sydney Ohio State University School of Medicine, Columbus, OH, USA

Reddy Sohil Ohio State University School of Medicine, Columbus, OH, USA

Bradshaw Jared Ohio State University School of Medicine, Columbus, OH, USA

Hennings Sarah Ohio State University School of Medicine, Columbus, OH, USA

Matsui Jennifer Ohio State University School of Medicine, Columbus, OH, USA

Klamer Brett Center for Biostatistics, The Ohio State University, Columbus, OH, USA

Upadhyay Rituraj Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA

Oliver Alexandria Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA

McGregor John Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA

Lonser Russell Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA

Prevedello Daniel Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA

Elder James Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA

Wu Kyle Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA

Prabhu Roshan Levine Cancer Institute, Atrium Health, Columbus, OH, USA

Zhu Simeng Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA

Singh Raj Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA

Beyer Sasha Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA

Grecula John Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA

Blakaj Dukagjin Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA

Thomas Evan Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA

Raval Raju Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA

Palmer Joshua Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA

8 2024
02 8 2024
02 8 2024
6 Suppl 1 2024 SNO/ASCO CNS Metastases Conference i29i30
© The Author(s) 2024. Published by Oxford University Press, the Society for Neuro-Oncology and the European Association of Neuro-Oncology.
2024
https://creativecommons.org/licenses/by-nc/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

Abstract

The treatment standard for patients with large or symptomatic brain metastases and limited intracranial disease is surgical resection followed by post-operative (post-op) stereotactic radiosurgery (SRS). The multicenter PROPS-BM cohort showed how pre-operative (pre-op) SRS may lead to a reduced incidence of radiation necrosis (RN), local failure (LF), and meningeal disease (MD) compared to historical controls. Fractionated treatments can deliver a higher biological effective dose and may reduce the incidence of LF and MD. We hypothesize that pre-op fractionated stereotactic radiation therapy (FSRT) will reduce the incidence rate of RN, MD, and LF when compared to patients who receive pre-op SRS. Patients who had surgical resection and pre-operative radiation to at least one brain metastasis at a single institution were retrospectively analyzed. Outcomes were evaluated on a per-lesion basis. The primary outcome was a composite endpoint defined by 1) LF, 2) MD, and/or 3) Grade 2 or higher (symptomatic) RN. 260 patients with 299 resected brain metastases were eligible for analysis. 64 metastases received SRS and 235 metastases received FSRT. 38 patients had multiple metastases resected pre-operatively. The median gross tumor volume was 4 ccs for SRS and 10 ccs for FSRT (p<0.001). Overall, 4 (6.3%) SRS and 6 (2.6%) FSRT patients experienced LF. 4 (6%) SRS and 21 (8.9%) FSRT patients experienced Grade 2 or higher RN. 3 (4.7%) SRS and 11 (4.7%) FSRT patients were diagnosed with MD. 14% of both SRS and FSRT patients experienced the composite endpoint. There were no statistically significant differences in outcome between these two treatment groups. In our study, pre-op SRS and FSRT both appear to be safe and effective options to treat resectable brain metastases. It is important to prospectively compare pre-op SRS and FSRT in matched cohorts to assess any differences in treatment efficacy and toxicity.
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