Standard Dose Versus Reduced Dose Single Fraction Preoperative Radiosurgery for Resected Brain Metastases (PROPS-BM) International Multicenter Cohort Study
Purpose: Single fraction preoperative stereotactic radiosurgery (SRS) has historically used a 10% to 20% dose reduction standard dosing. However, the effects of this dose reduction are not well characterized. The goal of this study was to compare outcomes and toxicity of standard dose (SD) with redu...
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Elsevier
2025-07-01
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| Series: | Advances in Radiation Oncology |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2452109425000818 |
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| author | Roshan S. Prabhu, MD, MS Rachel Russek, MPH Zachary K. Vaslow, MD Jennifer K. Matsui, PhD Neda Haghighi, MD Tu Dan, MD Mark V. Mishra, MD Erin S. Murphy, MD Susan Boyles, RTT Haley K. Perlow, MD Joshua D. Palmer, MD Cristian Udovicich, MD Toral R. Patel, MD Zabi Wardak, MD Graeme F. Woodworth, MD Alexander Ksendzovsky, MD, PhD Kailin Yang, MD, PhD Samuel T. Chao, MD Anthony L. Asher, MD Stuart H. Burri, MD |
| author_facet | Roshan S. Prabhu, MD, MS Rachel Russek, MPH Zachary K. Vaslow, MD Jennifer K. Matsui, PhD Neda Haghighi, MD Tu Dan, MD Mark V. Mishra, MD Erin S. Murphy, MD Susan Boyles, RTT Haley K. Perlow, MD Joshua D. Palmer, MD Cristian Udovicich, MD Toral R. Patel, MD Zabi Wardak, MD Graeme F. Woodworth, MD Alexander Ksendzovsky, MD, PhD Kailin Yang, MD, PhD Samuel T. Chao, MD Anthony L. Asher, MD Stuart H. Burri, MD |
| author_sort | Roshan S. Prabhu, MD, MS |
| collection | DOAJ |
| description | Purpose: Single fraction preoperative stereotactic radiosurgery (SRS) has historically used a 10% to 20% dose reduction standard dosing. However, the effects of this dose reduction are not well characterized. The goal of this study was to compare outcomes and toxicity of standard dose (SD) with reduced dose (RD) single fraction preoperative SRS. Methods and Materials: Patients with brain metastases from solid cancers, of which at least 1 lesion measuring ≤ 4 cm was treated with single fraction preoperative SRS and underwent planned resection were included from the Preoperative Radiosurgery for Brain Metastases (PROPS-BM international multicenter combined prospective and retrospective registries from 8 institutions. SD was a priori defined as ≥20 Gy for lesions ≤2 cm, ≥17 Gy for >2 to 3 cm, and ≥14 Gy for >3 to 4 cm based on institutional dosing practices. Multivariable and propensity score matched analyses were performed. Results: The cohort consisted of 307 patients with 307 preoperative SRS treated index lesions. SD was used in 124 patients (40%) and RD was used in 183 patients (60%). Median dose for lesions 0 to 2 cm (n = 73), >2 to 3 cm (n = 152), and >3 to 4 cm (n = 82) was 20, 18, and 15 Gy in the SD cohort and 16, 15, and 13 Gy in the RD cohort, respectively. There was no difference in 2-year cavity local recurrence (LR, 16% vs 15%, P = .69), adverse radiation effect (ARE, 8% vs 6%, P = .77), meningeal disease (2% vs 8%, P = .07), composite endpoint of cavity LR, ARE, or nodular meningeal disease (23% vs 22%, P = .86), or overall survival (49% vs 36%, P = .15). Results were similar within each specific lesion diameter subgroup and within the propensity score matched cohorts (n = 168). Conclusions: Both SD and RD single fraction preoperative SRS demonstrate excellent rates of cavity LR and ARE. Cavity LR risk increased with larger lesion size, regardless of SRS dose category. There does not seem to be an advantage in efficacy or toxicity for RD over SD single fraction preoperative SRS. Additional studies are warranted to optimize preoperative SRS dose and fractionation. |
| format | Article |
| id | doaj-art-249c90ec9d434faf955aacec22da39a2 |
| institution | OA Journals |
| issn | 2452-1094 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Advances in Radiation Oncology |
| spelling | doaj-art-249c90ec9d434faf955aacec22da39a22025-08-20T01:52:55ZengElsevierAdvances in Radiation Oncology2452-10942025-07-0110710179410.1016/j.adro.2025.101794Standard Dose Versus Reduced Dose Single Fraction Preoperative Radiosurgery for Resected Brain Metastases (PROPS-BM) International Multicenter Cohort StudyRoshan S. Prabhu, MD, MS0Rachel Russek, MPH1Zachary K. Vaslow, MD2Jennifer K. Matsui, PhD3Neda Haghighi, MD4Tu Dan, MD5Mark V. Mishra, MD6Erin S. Murphy, MD7Susan Boyles, RTT8Haley K. Perlow, MD9Joshua D. Palmer, MD10Cristian Udovicich, MD11Toral R. Patel, MD12Zabi Wardak, MD13Graeme F. Woodworth, MD14Alexander Ksendzovsky, MD, PhD15Kailin Yang, MD, PhD16Samuel T. Chao, MD17Anthony L. Asher, MD18Stuart H. Burri, MD19Atrium Health Levine Cancer Institute, Charlotte, North Carolina; Southeast Radiation Oncology Group, Charlotte, North Carolina; Corresponding author: Roshan S. Prabhu, MD, MSAtrium Health Levine Cancer Institute, Charlotte, North CarolinaCone Health Cancer Center, Greensboro, North CarolinaThe Ohio State University College of Medicine, Columbus, OhioPeter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Icon Cancer Centre, Epworth Centre, Richmond, Victoria, AustraliaUniversity of Texas Southwestern Medical Center, Dallas, TexasUniversity of Maryland School of Medicine, Greenebaum Comprehensive Cancer Center, Baltimore, MarylandTaussig Cancer Center, Cleveland Clinic, Cleveland, OhioCone Health Cancer Center, Greensboro, North CarolinaThe Ohio State University College of Medicine, Columbus, OhioThe Ohio State University College of Medicine, Columbus, OhioPeter MacCallum Cancer Centre, Melbourne, Victoria, AustraliaUniversity of Texas Southwestern Medical Center, Dallas, TexasUniversity of Texas Southwestern Medical Center, Dallas, TexasUniversity of Maryland School of Medicine, Greenebaum Comprehensive Cancer Center, Baltimore, MarylandUniversity of Maryland School of Medicine, Greenebaum Comprehensive Cancer Center, Baltimore, MarylandTaussig Cancer Center, Cleveland Clinic, Cleveland, OhioTaussig Cancer Center, Cleveland Clinic, Cleveland, OhioAtrium Health Levine Cancer Institute, Charlotte, North Carolina; Carolina Neurosurgery and Spine Associates, Charlotte, North CarolinaAtrium Health Levine Cancer Institute, Charlotte, North Carolina; Southeast Radiation Oncology Group, Charlotte, North CarolinaPurpose: Single fraction preoperative stereotactic radiosurgery (SRS) has historically used a 10% to 20% dose reduction standard dosing. However, the effects of this dose reduction are not well characterized. The goal of this study was to compare outcomes and toxicity of standard dose (SD) with reduced dose (RD) single fraction preoperative SRS. Methods and Materials: Patients with brain metastases from solid cancers, of which at least 1 lesion measuring ≤ 4 cm was treated with single fraction preoperative SRS and underwent planned resection were included from the Preoperative Radiosurgery for Brain Metastases (PROPS-BM international multicenter combined prospective and retrospective registries from 8 institutions. SD was a priori defined as ≥20 Gy for lesions ≤2 cm, ≥17 Gy for >2 to 3 cm, and ≥14 Gy for >3 to 4 cm based on institutional dosing practices. Multivariable and propensity score matched analyses were performed. Results: The cohort consisted of 307 patients with 307 preoperative SRS treated index lesions. SD was used in 124 patients (40%) and RD was used in 183 patients (60%). Median dose for lesions 0 to 2 cm (n = 73), >2 to 3 cm (n = 152), and >3 to 4 cm (n = 82) was 20, 18, and 15 Gy in the SD cohort and 16, 15, and 13 Gy in the RD cohort, respectively. There was no difference in 2-year cavity local recurrence (LR, 16% vs 15%, P = .69), adverse radiation effect (ARE, 8% vs 6%, P = .77), meningeal disease (2% vs 8%, P = .07), composite endpoint of cavity LR, ARE, or nodular meningeal disease (23% vs 22%, P = .86), or overall survival (49% vs 36%, P = .15). Results were similar within each specific lesion diameter subgroup and within the propensity score matched cohorts (n = 168). Conclusions: Both SD and RD single fraction preoperative SRS demonstrate excellent rates of cavity LR and ARE. Cavity LR risk increased with larger lesion size, regardless of SRS dose category. There does not seem to be an advantage in efficacy or toxicity for RD over SD single fraction preoperative SRS. Additional studies are warranted to optimize preoperative SRS dose and fractionation.http://www.sciencedirect.com/science/article/pii/S2452109425000818 |
| spellingShingle | Roshan S. Prabhu, MD, MS Rachel Russek, MPH Zachary K. Vaslow, MD Jennifer K. Matsui, PhD Neda Haghighi, MD Tu Dan, MD Mark V. Mishra, MD Erin S. Murphy, MD Susan Boyles, RTT Haley K. Perlow, MD Joshua D. Palmer, MD Cristian Udovicich, MD Toral R. Patel, MD Zabi Wardak, MD Graeme F. Woodworth, MD Alexander Ksendzovsky, MD, PhD Kailin Yang, MD, PhD Samuel T. Chao, MD Anthony L. Asher, MD Stuart H. Burri, MD Standard Dose Versus Reduced Dose Single Fraction Preoperative Radiosurgery for Resected Brain Metastases (PROPS-BM) International Multicenter Cohort Study Advances in Radiation Oncology |
| title | Standard Dose Versus Reduced Dose Single Fraction Preoperative Radiosurgery for Resected Brain Metastases (PROPS-BM) International Multicenter Cohort Study |
| title_full | Standard Dose Versus Reduced Dose Single Fraction Preoperative Radiosurgery for Resected Brain Metastases (PROPS-BM) International Multicenter Cohort Study |
| title_fullStr | Standard Dose Versus Reduced Dose Single Fraction Preoperative Radiosurgery for Resected Brain Metastases (PROPS-BM) International Multicenter Cohort Study |
| title_full_unstemmed | Standard Dose Versus Reduced Dose Single Fraction Preoperative Radiosurgery for Resected Brain Metastases (PROPS-BM) International Multicenter Cohort Study |
| title_short | Standard Dose Versus Reduced Dose Single Fraction Preoperative Radiosurgery for Resected Brain Metastases (PROPS-BM) International Multicenter Cohort Study |
| title_sort | standard dose versus reduced dose single fraction preoperative radiosurgery for resected brain metastases props bm international multicenter cohort study |
| url | http://www.sciencedirect.com/science/article/pii/S2452109425000818 |
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