Top Line: Does the timing of post-op SRS for resected brain metastases influence local control?
The Study: While several studies have shown correlations between compressed “treatment package time” and longer survival, those are wrought with confounding variables. In other words, many reasons for a treatment delay are also likely a reason for a shorter life expectancy. We like this study because it correlates package time with an endpoint that has a closer causal relationship: local control. It looks back at 133 consecutive patients receiving stereotactic radiosurgery (SRS) for resected brain mets (median size 2.9 cm) at Cornell between 2012 and 2018. The overall median time to SRS was a bit on the long side at 37 days, but that makes for a nice evaluation of outcomes over a broader time span. Median time from surgery to SRS was 34 days for patients without local recurrence (n=111) and 61 days for those with a local recurrence (n=22). When dichotomized by whether post-op SRS was delivered within or after 4 weeks from surgery, local recurrence rates were 2% and 24%, respectively. Receipt of SRS within 4 weeks was also significantly associated with longer local recurrence-free survival and, interestingly, less distant brain failure.
TBL: Speak with your friendly neighborhood neurosurgeon about timely referrals for post-op SRS as treatment completion within 4 weeks is associated with better intracranial disease outcomes. | Roth O’Brien, Pract Radiat Oncol 2021