Shorter time to stereotactic radiosurgery after brain metastases resection improves patient outcomes

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Doctor and patient at MSK’s Multidisciplinary Brain Metastasis Clinic

Local control rates and overall survival (OS) were significantly higher for patients with brain metastases treated with adjuvant stereotactic radiosurgery (SRS) within two months of resection, compared to longer time intervals, according to our new study published recently in Neuro-Oncology Practice.1

Brain metastases are much more common than primary brain tumors 2 and develop in about 20 to 40% of cancer patients. Current treatment for symptomatic patients involves surgical resection followed by postoperative radiation. There is an increasing preference for adjuvant SRS, which was pioneered at Memorial Sloan Kettering Cancer Center, as it results in significantly improved local control rates, fewer cognitive side effects, and improved quality of life compared to whole-brain radiation therapy.3,4 However, the impact of length of time between resection and SRS on patient outcomes has been unclear.

Our study — and the implications of our findings

We retrospectively analyzed outcomes for 282 patients who were diagnosed with brain metastases and treated with surgical resection followed by SRS at MSK’s Multidisciplinary Brain Metastasis Clinic between 2013 and 2016. The median time interval between surgery and SRS was 34 days. Longer intervals were significantly associated with higher recurrence rates at one year, with rates of 6.1%, 9.2%, and 27.3% for patients who received SRS at intervals of within one month, between one and two months, and greater than two months, respectively. OS was significantly worse for patients who received SRS within 62 to 90 days after surgery versus 62 days or earlier (HR = 2.14, p = 0.03).1

Insert Graph with time intervals (horizontal) and recurrence rates (vertical)

The timing and order of treatment modalities to address brain metastases is complex, especially for patients undergoing systemic treatment for primary cancers. For example, administering steroids to manage inflammation after radiation obviates simultaneous treatment with systemic immunotherapy.

Nelson Moss
“Our study findings underscore the importance of multidisciplinary treatment planning to provide the best care options as soon as possible. Most of our patients resume their cancer care within two weeks,” said Nelson Moss, MD, a neurosurgeon who co-leads MSK’s Multidisciplinary Brain Metastasis Clinic, is a senior author on the study, and is highly focused on improving outcomes in patients with brain metastases. “We collaborate often with oncologist colleagues outside MSK on medical opinions and treatment recommendations.”

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Learn more about MSK’s Multidisciplinary Brain Metastasis Clinic

At MSK, dedicated neurosurgeons, radiation oncologists, neuroradiologists, physiatrists, and clinical trial experts provide care exclusively in our recently launched Multidisciplinary Brain Metastasis Clinic. They collaborate to create an individualized treatment plan for each patient, ensuring the appropriate treatment modalities are delivered in the optimal order as quickly as possible. They are also focused on providing patients with recurrent or refractory brain metastasis with novel clinical trials and treatment options.

As one of few centers using the most advanced diagnostic and treatment options for brain metastasis care, MSK treats a high volume of patients with brain metastases annually on expedited timelines. We offer same-day planning and treatment for patients requiring immediate attention, including planning MRI, radiation oncology counseling, CT simulation with mask fitting, radiation dose planning, and SRS delivery. This approach allows the Multidisciplinary Brain Metastasis Clinic to treat brain metastasis efficiently while the patient retains their oncologic care with their own doctors outside MSK.

Learn more about MSK’s Multidisciplinary Brain Metastasis Clinic.

To refer a patient, call our dedicated Multidisciplinary Brain Metastasis Clinic hotline at 212-619-5837, and we can help set up an appointment within 48 hours or same day radiation treatment, if needed.

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  1. Bander ED, Yuan M, Reiner AS, et al. Durable 5-year local control for resected brain metastases with early adjuvant SRS: the effect of timing on intended-field control. Neurooncol Pract. 2021;8(3):278-289.
  2. Barnholtz-Sloan JS, Sloan AE, Davis FG, Vigneau FD, Lai P, Sawaya RE. Incidence proportions of brain metastases in patients diagnosed (1973 to 2001) in the Metropolitan Detroit Cancer Surveillance System. J Clin Oncol. 2004;22(14):2865–2872.
  3. Brown PD, Jaeckle K, Ballman KV, et al. Effect of radiosurgery alone vs radiosurgery with whole brain radiation therapy on cognitive function in patients with 1 to 3 brain metastases: a randomized clinical trial. JAMA. 2016;316(4):401–409.
  4. Chang EL, Wefel JS, Hess KR, et al. Neurocognition in patients with brain metastases treated with radiosurgery or radiosurgery plus whole-brain irradiation: a randomised controlled trial. Lancet Oncol. 2009;10(11):1037–1044.