ArticleAdvances in radiation oncology2025
Preoperative Stereotactic Radiosurgery for Brain Metastases: A Phase 1 Dose Escalation Study Demonstrating Reduced Leptomeningeal Disease.
Article in Advances in radiation oncology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
3 citing papers in PubMed.
- Review
- Comment on: "Neoadjuvant gamma knife surgery for metastatic brain tumor: clinical use and impact on leptomeningeal seeding".Journal of neuro-oncology · 2025Article
- Clinical factors associated with leptomeningeal disease in patients with melanoma brain metastasis.Neuro-oncology advancesArticle
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Authors and funding
8 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Purpose: Preoperative stereotactic radiosurgery (SRS) has been proposed as a strategy to reduce nodular leptomeningeal disease (nLMD) after resection of brain metastases by devitalizing tumor cells before surgical manipulation. This study aimed to determine the safety of preoperative SRS via a phase 1 dose escalation trial and compare outcomes-including nLMD, classical LMD, local control, and overall survival (OS)-between preoperative and postoperative treatment cohorts. Methods and Materials: A phase 1 trial evaluated the safety of single-fraction preoperative SRS at escalating doses (12 and 15 Gy) in patients with tumors 2 to 6 cm. Adverse events were assessed per National Cancer Institute Common Terminology Criteria for Adverse Events v4.0, with dose-limiting toxicity (DLT) defined as high-grade neurologic or wound complications. Retrospective analysis included an expanded preoperative cohort (n = 95) and a historical postoperative cohort (n = 107). Outcomes were analyzed with Kaplan-Meier and Cox proportional hazards models. Results: Fifteen Gy was well tolerated in the phase 1 cohort, with no DLTs in larger tumors (4-6 cm) and 3 DLTs in smaller tumors, not meeting thresholds for dose de-escalation. In the expanded analysis, preoperative SRS significantly reduced rates of nLMD (7.4% vs 27.1%, Conclusions: Preoperative SRS to 15 Gy is safe for tumors 2 to 6 cm and significantly reduces nLMD without compromising local control or OS. These findings support preoperative SRS as a viable treatment strategy and justify further investigation into optimal dosing and patient selection.
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Registered trials
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