Cancer that spreads to the brain from one other a part of the body comparable to lung or breast is known as a metastatic brain tumor. As metastatic brain tumors grow, they may cause symptoms comparable to headaches, seizures and weakness or balance issues. In some patients, surgery and stereotactic radiosurgery (SRS) might help alleviate these symptoms in patients who’ve a limited variety of tumors.

Despite what its name implies, SRS is not actually a surgery but as a substitute involves highly focused radiation that targets tumors while minimizing the results on surrounding healthy tissue. The treatment is commonly used after a patient undergoes surgery to remove brain tumors in a process called postoperative SRS. Nonetheless, SRS may also be given before surgery, which is known as preoperative SRS.

In a latest study from Wake Forest University School of Medicine and Atrium Health Levine Cancer Institute, researchers highlight improved outcomes for patients treated with preoperative SRS, particularly in rates of tumor reoccurrence, antagonistic radiation effects and spread of tumor cells to the fluid outside of the brain, which is known as meningeal disease.

The study findings appear online today in JAMA Oncology.

“Postoperative SRS is currently the usual of care in these patients, but there’s a growing body of research that shows preoperative SRS has benefits,” said Roshan Prabhu, M.D., a radiation oncologist at Atrium Health Levine Cancer Institute, in Charlotte, North Carolina, and an adjunct associate professor of radiation oncology at Wake Forest University School of Medicine.

Based on Prabhu, who’s the lead corresponding writer of the study, there are multiple the explanation why preoperative SRS could also be higher than postoperative SRS. In preoperative SRS, the tumor is undamaged, so providers can more precisely see the realm that needs treatment.

We have also conducted research that shows there’s the next risk of tumor cells spreading to the fluid across the brain when surgery occurs first. Preoperative SRS might help minimize that risk.”

Roshan Prabhu, M.D., radiation oncologist at Atrium Health Levine Cancer Institute

Within the study, researchers compiled data from a multicenter and international cohort of 404 patients who underwent preoperative SRS and surgical resection of brain metastases.

To research preoperative SRS outcomes, researchers checked out cavity local reoccurrence, antagonistic radiation effects and meningeal disease, which occurs when the cancer spreads to nearby fluid and might grow on the surface of the brain. Opposed radiation effects include swelling, inflammation and radiation necrosis, a condition by which there’s not enough blood supply to tissues and can lead to long-term swelling.

The 2-year cavity local reoccurrence rate was 13.7%. The 2-year meningeal disease rate was 5.8%, and the two-year symptomatic antagonistic radiation effect rate was 5%.

While this study did circuitously compare outcomes with patients treated with postoperative SRS, recent studies show postoperative SRS cavity reoccurrence rates to be 22% to 39%, meningeal disease rates to be 16% to 21%, and antagonistic radiation effects rates to be 7% to 18%.

Moreover, novel risk aspects for these outcomes after treatment with preoperative SRS were described, comparable to extent of resection, tumor type, variety of preoperative SRS fractions used and style of surgery.

“We found negative outcomes to be notably low with preoperative SRS, especially when put next to what is anticipated after postoperative SRS,” Prabhu said. “By simply changing the sequencing of treatment, it will possibly potentially improve outcomes and increase survival.”

These data served as the idea for a national phase 3 randomized clinical trial comparing preoperative SRS to postoperative SRS, which is currently enrolling patients at multiple sites including Atrium Health Levine Cancer Institute.

Atrium Health Levine Cancer Institute and Atrium Health Wake Forest Baptist’s National Cancer Institute-designated Comprehensive Cancer Center are a part of Atrium Health’s combined cancer program, and Wake Forest University School of Medicine is the tutorial core of Advocate Health, of which Atrium Health is a component.

Source:

Atrium Health Wake Forest Baptist

Journal reference:

Prabhu, R. S., et al. (2023) Risk Aspects for Progression and Toxic Effects After Preoperative Stereotactic Radiosurgery for Patients With Resected Brain Metastases. JAMA Oncology. doi.org/10.1001/jamaoncol.2023.1629.