Multicenter prospective cohort study of impact of timing of postoperative stereotactic surgery on outcomes after resection of brain metastases

Adjuvant stereotactic radiosurgery (SRS) after resection of brain metastases (BrMs) is associated with decreased risk of local failure (LF) but also with potential for posttreatment adverse radiation effects (PTREs). A multicenter prospective study in the USA investigated the impact of timing of SRS after resection of BrMs on LF and PTREs. This cohort study of 438 patients found that adjuvant SRS delivered within 30 days of surgery was associated with less LF; but, if it was delivered within 21 days of surgery, it was associated with more PTREs and, within 14 days of surgery, the most PTREs, Adjuvant SRS delivered within 22 to 30 days was associated with lower rates of PTRE while still maintaining a low LF rate. The authors conclude that the optimal timing for adjuvant SRS of resected brain metastases falls within 22 to 30 days after surgery to minimize both LF and PTREs