Preoperative Stereotactic Radiosurgery for Brain Metastases

Neurosurgical resection is an important treatment modality for patients with brain metastases, especially those with large, symptomatic tumors. Adjuvant whole brain radiotherapy (WBRT) or stereotactic radiosurgery (SRS) to the resection cavity is important to maximize local control. Postoperative SRS has been shown to be an alternative to WBRT with less impact. The SRS target for postoperative SRS can be challenging and pattern of failure demonstrates increased leptomeningeal disease. Preoperative SRS is emerging as a new strategy for resectable brain metastases. This allows for straightforward target delineation, a reduced risk of radiation necrosis, and a reduced risk of nodular leptomeningeal disease. As systemic therapies improve the control of extracranial metastatic disease and patients are living longer, reducing the burden of radiation side effects is increasingly important.