Disease progression, adverse radiation effects found to be low in patients undergoing preoperative SRS (Two year recurrence only 13.7% vs. 22% - 39%)

Medical Xpress / Atrium Health Wake Forest Baptist / JAMA Oncology ^ | June 8, 2023 | Roshan S. Prabhu et al

[ConservativeMind]

Cancer that spreads to the brain from another part of the body such as lung or breast is called a metastatic brain tumor. In some patients, surgery and stereotactic radiosurgery (SRS) can help alleviate these symptoms in patients who have a limited number of tumors.

Despite what its name implies, SRS isn't actually a surgery but instead involves highly focused radiation that targets tumors while minimizing the effects on surrounding healthy tissue. The treatment is often used after a patient undergoes surgery to remove brain tumors in a process called postoperative SRS. However, SRS can also be given before surgery, which is called preoperative SRS.

In a study, researchers highlight improved outcomes for patients treated with preoperative SRS, particularly in rates of tumor recurrence, adverse radiation effects and spread of tumor cells to the fluid outside of the brain, which is called meningeal disease.

According to Prabhu, there are multiple reasons why preoperative SRS may be better than postoperative SRS. In preoperative SRS, the tumor is intact, so providers can more precisely see the area that needs treatment.

"We've also conducted research that shows there's a higher risk of tumor cells spreading to the fluid around the brain when surgery occurs first," Prabhu said. "Preoperative SRS can help minimize that risk."

In the study, researchers compiled data from patients who underwent preoperative SRS and surgical resection of brain metastases.

The two-year cavity local recurrence rate was 13.7%. The two-year meningeal disease rate was 5.8%, and the two-year symptomatic adverse radiation effect rate was 5%.

While this study did not directly compare outcomes with patients treated with postoperative SRS, recent studies show postoperative SRS cavity recurrence rates to be 22% to 39%, meningeal disease rates to be 16% to 21%, and adverse radiation effects rates to be 7% to 18%.

[ConservativeMind]

Simply changing the order of this therapy provides huge benefits to recurrence and various adverse effects.

[ConservativeMind]

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[Steely Tom]

I thought of this idea when I was in eighth grade. I mean, rotating the beam around a common intersection point to decrease radiation exposure to the tissue around the tumor.

I took the idea a step further though. My idea was to inject the patient with some molecule that turns into a solid plastic block at the intersection point, through a reaction catalyzed by cumulative radiation exposure.

Turns out the first one is possible, the second one... not so much. Ah well.

Of course, I didn’t know enough to call it “stereotactic radiation surgery” at age 13.