Preoperative Versus Postoperative Fractionated Stereotactic Radiotherapie: A Single Institution Analyse of 534 Resected Metastases

Patients with large or symptomatic brain metastases typically have surgery followed by postoperative (post-op) stereotactic radiosurgery. However, post-op stereotactic radiosurgery leads to elevated rates of radiation necrosis (RN), nodular meningeal disease (nMD), and local failure (LF) when compared with whole brain radiation therapy. Fractionated stereotactic radiation therapy (FSRT) can deliver a higher biological effective dose and may reduce the risk of LF, and preoperative (pre-op) treatments may reduce the risk of RN and nMD through treating smaller volumes and tumor sterilization.