A recent study published in the journal Neurosurgery suggests that postoperative stereotactic radiosurgery (SRS) therapy is the most appropriate treatment modality for patients with brain metastases who undergo total tumor dissection (GDP) and require low-volume radiation therapy. Researcher Jared Gans, MD, PhD, of the University of Miami, Florida, and colleagues noted, “As multiple solid tumor treatment techniques have advanced, patient survival rates have improved while neurocognitive side effects of whole brain radiation therapy have emerged. It is important to understand the role of alternative treatment options, particularly SRS, as an adjunct to surgical resection of metastatic intracranial occupying lesions.” Study Overview Researchers conducted a systematic literature review and analyzed 14 studies with a total of 626 patients to evaluate outcomes of adjuvant stereotactic radiosurgery performed after surgical resection for metastatic intracranial tumors only. The mean patient survival was 14.3 months. Higher incidence of solitary metastases in the cohort was the only specific preoperative or patient-specific factor associated with higher overall survival. Crude tumor growth suppression was achieved in an average of 83% of patients, with tumors confined to the primary site. The median local control rate at 1 year was found to be 81% (mean 85%) in half of the studies. Local control rates were independently associated with smaller tumor volume and total tumor excision (GDP) rates after radiotherapy. 49% of patients experienced distant intracranial recurrence (failure) and 29% required salvage WBRT, which was the most common salvage treatment in the study. Both the crude local control rate and median overall survival were unaffected by the size of the radiosurgical treatment boundary. The authors noted that the advantage of adding 1 mm to 3 mm of radiotherapy coverage around the resection cavity for improving local control rates and overall survival remains controversial. Large borders result in radiation-related parenchymal changes that, although asymptomatic, carry the risk of cognitive impairment,” the authors write. Complications resulting from radiation therapy, such as edema, may be underreported.” Dr. Gans and his research team said, “A direct comparison of patient satisfaction with WBRT and SRS and quality of life is necessary to adequately compare the serious complications of each treatment.” The study also showed that smaller target tumor size and the efficacy of radiation therapy and total resection increased local control rates.