Preoperative Stereotactic Radiotherapy Safe and Preferable for Brain Metastases: JAMA

A new study published in the Journal of American Medical Association showed that preoperative stereotactic radiotherapy (SRT) is as safe as postoperative SRT for patients with resectable brain metastases. It also led to higher treatment completion rates and a shorter time to treatment completion.

Clinically meaningful information on management results is provided by comparing the logistical and toxic effects of preoperative and postoperative SRT. Thus, to assess the preoperative and postoperative SRT logistics and safety profiles in patients with brain metastases, this study was carried out.

The patients who were 18 years of age or older and had a scheduled surgical resection were enrolled in this single-institution phase 3 randomized clinical study. These patients were the candidates for SRT within 30 days following surgical resection and have an Eastern Cooperative Oncology Group Performance Status score of 2 or above. Data collection took place between December 2018 and August 2023, while data analysis took place between September 2023 and December 2024.

Within a month of receiving radiation therapy, patients who were randomly assigned to the preoperative SRT cohort underwent SRT (in 1–5 fractions) and surgical resection. Within a month following surgery, patients who were randomly assigned to the postoperative SRT cohort had resection and postoperative SRT.

Almost, 56 (54.4%) of the 103 patients were men, and their median age was 59 years old (range: 26-83). 70 (84%) of the patients had 1-4 brain metastases, eleven (13%) had 5-10, and two (2%) had more than 10.

Of the patients, 83 (80.6%) had both radiation and surgery. When compared to 38 (73%) in the postoperative group, 45 (88%) in the preoperative SRS/SRT group finished both treatments. 

Postprocedural events and 30-day morbidity did not differ significantly. In the preoperative group, the median interval between surgery and SRT was shorter (6 days vs. 22 days; P <.001). Additionally, the preoperative group had a shorter median time from randomization to getting both treatments (10 vs. 32.5 days; P <.001).

Overall, the results of this randomized clinical trial show little variation in 30-day postoperative morbidity, which is important for the real-world population providing preoperative or postoperative SRS/SRT. Additionally, it offers distinct insights from other clinical studies that are presently enrolling, which may have different approaches and methodologies.

Reference:

Yeboa, D. N., Li, J., Lin, R., Prabhu, S. S., Beckham, T. H., Woodhouse, K., Swanson, T. A., Weinberg, J. S., Wang, X., Chi, X., Ejezie, C. L., Suki, D., Wang, C., Ene, C., McCutcheon, I. E., McGovern, S., McAleer, M. F., Tom, M., Ghia, A., … Ferguson, S. D. (2025). Therapy, safety, and logistics of preoperative vs postoperative stereotactic radiation therapy: A preliminary analysis of a randomized clinical trial. JAMA Oncology. https://doi.org/10.1001/jamaoncol.2025.1770