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Stereotactic Radiosurgery to Prevent Local Recurrence of Brain Metastasis After Surgery: Neoadjuvant Versus Adjuvant

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Gamma Knife Neurosurgery in the Management of Intracranial Disorders II

Part of the book series: Acta Neurochirurgica Supplement ((NEUROCHIRURGICA,volume 128))

Abstract

Over the past 15–20 years, stereotactic radiosurgery (SRS) has become the dominant method for treating patients with brain metastases (BM). The role of surgery for management of large tumors also remains important. Combining these two treatment modalities may well achieve the best local control, safety, and symptomatic relief in cases of neoplasms for which resection is desirable. After 10 years of retrospective studies that suggested patients might do better if surgery were followed by early adjuvant SRS, a prospective, randomized, controlled trial was conducted to compare such treatment with postoperative observation after tumor removal, and it showed significantly better local control in the former cohort, especially in smaller lesions, but no difference in overall survival. On the other hand, in the past 5 years, some groups have argued that neoadjuvant SRS before resection of BM might be superior to adjuvant SRS, while no clinical trial has yet been concluded that compares these two treatment strategies. For now, adjuvant and neoadjuvant SRS show evidence of utility in achieving better local control after surgical removal of BM in comparison with surgery alone, but no specific guidelines exist favoring one method over the other, and both should be considered beneficial in clinical care.

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  1. Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Ian E. McCutcheon

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  1. Faculty of Advanced Techno-Surgery and Department of Neurosurgery, Tokyo Women’s Medical University, Tokyo, Japan

    Mikhail F. Chernov

  2. Gamma Knife Unit, Department of Neurosurgery, and Faculty of Advanced Techno-Surgery, Tokyo Women's Medical University, Tokyo, Tokyo, Japan

    Motohiro Hayashi

  3. Department of Neurosurgery, University of Minnesota Medical School, Minnesota, MN, USA

    Clark C. Chen

  4. Department of Neurosurgery, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA

    Ian E. McCutcheon

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McCutcheon, I.E. (2021). Stereotactic Radiosurgery to Prevent Local Recurrence of Brain Metastasis After Surgery: Neoadjuvant Versus Adjuvant. In: Chernov, M.F., Hayashi, M., Chen, C.C., McCutcheon, I.E. (eds) Gamma Knife Neurosurgery in the Management of Intracranial Disorders II. Acta Neurochirurgica Supplement, vol 128. Springer, Cham. https://doi.org/10.1007/978-3-030-69217-9_9

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