Preoperative irradiation of brain metastases New treatment concepts in radiation oncology

Background: Symptomatic brain metastases should be resected for permanent symptom relief. Postoperative radiotherapy can significantly reduce the risk of local recurrence; therefore, focal irradiation of the resection cavity is an established procedure for this purpose.Objectives: Does neoadjuvant irradiation of the brain metastasis prior to resection represent an alternative procedure?Methods: To evaluate the available literature on preoperative radiotherapy before metastatic resection in terms of technique, safety, and clinical benefit.Results: Since 2014, several, mostly retrospective studies on neoadjuvant radiotherapy have been published. In addition to simplified radiation planning and shortened overall treatment time, local recurrence rates were only 15.0 and 17.9% after 1 and 2 years, respectively.Conclusions: Based on current trial data, neoadjuvant radiotherapy of brain metastases may become established as an alternative to postoperative radiation after resection for a subgroup of patients. However, randomized data are still pending.