Options of combined treatment of patients with oligometastatic brain lesions

Abstract

Objective. To evaluate the efficacy and safety of combining neoadjuvant stereotactic radiosurgery (SRS) with surgical resection of the dominant brain metastasis in patients with oligometastatic disease (OMD). Material and methods. Forty patients with 2—5 brain metastases meeting ESTRO–EORTC OMD criteria underwent whole-body PET/CT for staging. Neoadjuvant SRS was delivered to the dominant lesion (15—18 Gy, CTV + 1 mm) and to smaller metastases (up to 24 Gy, CTV + 0 mm). Surgical removal of the dominant metastasis followed within 1—3 days after irradiation. Results. Median overall survival reached 12 months, exceeding the 6—9 months typically reported for either surgery or SRS alone. Early postoperative mortality occurred in 5% of patients (brainstem ischemia). No increase in postoperative edema, wound complications, or radiation-induced necrosis was observed. Histological evaluation showed no significant morphological changes after preoperative SRS, supporting the safety of surgery within 24—72 hours post-irradiation. Conclusions. Combining neoadjuvant SRS with surgical resection of the dominant metastasis provides an effective and safe strategy for achieving durable local control in oligometastatic brain disease. This approach shortens the duration of local treatment, facilitates earlier systemic therapy, reduces the risk of leptomeningeal spread and radionecrosis, and may improve overall survival.