Do you routinely recommend SRS to the surgical bed after resection of a single brain metastasis?
The retrospective series quote a local control rate of 85-90% at one year and the current NCCN guidelines list this as an option following surgery for limited mets (level 2B v. level 1 evidence for WBRT). Now that ASTRO is advocating against adjuvant whole brain radiation therapy following SRS for limited brain metastases (in the Choose Wisely Campaign), do you think a push towards postop SRS is next?
Answer from: Radiation Oncologist at Community Practice
At our institution it is routinely done although local control reported in literature varies from 60 to 85 percent. One problem with this approach is defining the surgical cavity target accurately. To overcome this, retrospective data suggests giving 2mm margin around the cavity to improve local con...
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Answer from: Radiation Oncologist at Academic Institution
As @Sushil Beriwal mentioned, the randomized trial is nearly complete and we try to put these patients on protocol if at all possible to generate the level I evidence we need to make this decision. Off protocol, I prefer observation over SRS to the cavity and treating recurrent disease wi...