Department of Radiation Oncology, Mayo Clinic, 4500 San Pablo Road South, Jacksonville, FL, 32224, USA.
Department of Radiation Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, USA.
J Neurooncol. 2023 Oct;165(1):21-28. doi: 10.1007/s11060-023-04466-5. Epub 2023 Oct 27.
Stereotactic radiosurgery (SRS) is a method of delivering conformal radiation, which allows minimal radiation damage to surrounding healthy tissues. Adjuvant radiation therapy has been shown to improve local control in a variety of intracranial neoplasms, such as brain metastases, gliomas, and benign tumors (i.e., meningioma, vestibular schwannoma, etc.). For brain metastases, adjuvant SRS specifically has demonstrated positive oncologic outcomes as well as preserving cognitive function when compared to conventional whole brain radiation therapy. However, as compared with neoadjuvant SRS, larger post-operative volumes and greater target volume uncertainty may come with an increased risk of local failure and treatment-related complications, such as radiation necrosis. In addition to its role in brain metastases, neoadjuvant SRS for high grade gliomas may enable dose escalation and increase immunogenic effects and serve a purpose in benign tumors for which one cannot achieve a gross total resection (GTR). Finally, although neoadjuvant SRS has historically been delivered with photon therapy, there are high LET radiation modalities such as carbon-ion therapy which may allow radiation damage to tissue and should be further studied if done in the neoadjuvant setting. In this review we discuss the evolving role of neoadjuvant radiosurgery in the treatment for brain metastases, gliomas, and benign etiologies. We also offer perspective on the evolving role of high LET radiation such as carbon-ion therapy.
PubMed was systemically reviewed using the search terms "neoadjuvant radiosurgery", "brain metastasis", and "glioma". ' Clinicaltrials.gov ' was also reviewed to include ongoing phase III trials.
This comprehensive review describes the evolving role for neoadjuvant SRS in the treatment for brain metastases, gliomas, and benign etiologies. We also discuss the potential role for high LET radiation in this setting such as carbon-ion radiotherapy.
Early clinical data is very promising for neoadjuvant SRS in the setting of brain metastases. There are three ongoing phase III trials that will be more definitive in evaluating the potential benefits. While there is less data available for neoadjuvant SRS for gliomas, there remains a potential role, particularly to enable dose escalation and increase immunogenic effects.
立体定向放射外科（SRS）是一种提供适形辐射的方法，可将对周围健康组织的辐射损伤最小化。辅助放疗已被证明可以改善多种颅内肿瘤（如脑转移瘤、神经胶质瘤和良性肿瘤（如脑膜瘤、前庭神经鞘瘤等）的局部控制。对于脑转移瘤，与常规全脑放疗相比，辅助 SRS 特别能带来积极的肿瘤学结果并保留认知功能。然而，与新辅助 SRS 相比，较大的术后体积和更大的靶区不确定性可能会增加局部失败和治疗相关并发症（如放射性坏死）的风险。除了在脑转移瘤中的作用外，高级别神经胶质瘤的新辅助 SRS 可能能够提高剂量递增并增加免疫原性效应，并对无法实现完全切除（GTR）的良性肿瘤有一定作用。最后，尽管新辅助 SRS 历史上一直采用光子治疗，但存在诸如碳离子治疗等高 LET 辐射方式，可能会对组织造成辐射损伤，如果在新辅助治疗中采用这些方式，应该进一步研究。在这篇综述中，我们讨论了新辅助放射外科在脑转移瘤、神经胶质瘤和良性病因治疗中的作用不断发展。我们还对碳离子治疗等高 LET 辐射的作用不断发展提供了一些看法。
使用“新辅助放射外科”、“脑转移瘤”和“神经胶质瘤”等检索词，对 PubMed 进行系统综述。还查阅了“ClinicalTrials.gov”，以纳入正在进行的 III 期试验。
本综述全面描述了新辅助 SRS 在脑转移瘤、神经胶质瘤和良性病因治疗中的作用不断发展。我们还讨论了在这种情况下高 LET 辐射（如碳离子放疗）的潜在作用。
早期临床数据对脑转移瘤的新辅助 SRS 非常有前景。目前有三项正在进行的 III 期试验将更能明确评估其潜在益处。虽然新辅助 SRS 治疗神经胶质瘤的数据较少，但仍有潜在作用，特别是可以提高剂量递增和增强免疫原性效应。
