The role of preoperative stereotactic radiotherapy in the management of resectable brain metastases: A systematic review.

Objectives: This systematic review assessed the efficacy and safety of preoperative stereotactic radiotherapy (PreopSRT) in the treatment of resectable brain metastases (BM).

Methods: A PRISMA systematic review was conducted using Web of Science, Scopus, and PubMed. The search terms included "(brain or cerebral) and (metastasis or metastases) and (radiotherapy or radiosurgery or radiation) and (neoadjuvant or preoperative)." Of the 2061 articles identified, 12 studies met the inclusion criteria: patients with resectable BM who received PreopSRT in single or multiple fractions. Literature reviews, protocols, and studies on salvage resections were excluded.

Results: Local control at 6 months ranged from 81.8 to 100%, with over 95% control reported in 4 studies, reaching 100% in 3 series. At 12 months, local control ranged from 49.1 to 95%. Data for 24-month local control were available for only 3 studies, ranging from 73 to 97.1%. Multiple fractions appeared to be more effective. PreopSRT showed a rate of leptomeningeal recurrence between 0 and 17% and a rate of radionecrosis from 3.5 to 10.5% at 1 year.

Conclusion: This PRISMA review highlights the growing interest in preoperative stereotactic radiotherapy, which appears at least as effective and potentially less toxic than postoperative treatment. Phase III trials are needed to confirm its clinical use.