Risk factors for progression and toxic effects after preoperative stereotactic radiosurgery for resectable brain metastases

Preoperative stereotactic radiosurgery (SRS) has been demonstrated to be a feasible alternative to postoperative SRS for resectable brain metastases (BMs). The multinational PROPS-BM cohort study of 404 patients with resected brain metastases found that after preoperative SRS the cavity local recurrence, meningeal disease, and adverse radiation effect rates at 2 years were 13.7%, 5.8%, and 7.4%, respectively. The median overall survival was 17.2 months (95% CI 14.1-21.3). Several novel prognostic tumor and treatment factors after preoperative SRS were identified, including extent of resection, type of resection, fractionation, target margin expanseion, and primary tumor type. The authors conclude that preoperative SRS for BMs has a favorable risk-benefit profile.