术前放射外科治疗（SRS）是手术切除的脑转移瘤（BM）的可行替代方案。大多数报道的术前SRS研究使用了单剂量SRS（SF-SRS）。该研究的目标是比较术前SF-SRS与多剂量（3-5剂量）SRS（MF-SRS）在大型国际多中心队列（XXX）中的结果和毒性。从8个机构纳入了固体癌症的BM患者，其中至少有1个病灶经过术前SRS治疗，并计划切除。可以进行同步完整BM的SRS治疗。排除标准包括先前或计划的全脑放疗。使用累积发病率与死亡竞争风险估计颅内疗效。进行了倾向性匹配（PSM）分析。研究队列包括404位患者，416个切除的索引病变，其中317例患者（78.5%）使用了SF-SRS，87例患者（21.5%）使用了MF-SRS。SF-SRS的中位剂量为15 Gy（1剂量），MF-SRS的中位剂量为24 Gy（3剂量）。单变量分析表明，与MF-SRS相比，SF-SRS与腔体局部复发（LR）相关较高（2年：16.3% vs. 2.9%，p=0.004），在多变量分析中也得到证实。PSM得出81对匹配组（n=162）。PSM分析还表明，SF-SRS的腔体LR率显著更高（2年：19.8% vs. 3.3%，p=0.003）。在任何分析中，两组之间的不良放射效应（ARE），脑膜病（MD）或总生存期（OS）均无差异。术前MF-SRS与未匹配和PSM分析均显示腔体LR风险显著降低。根据分割方式，ARE，MD或OS均无差异。MF-SRS可能是手术切除的脑转移瘤的新辅助放射治疗首选。需要进行进一步的确认性研究。一项单剂量术前与术后SRS的III期随机试验（NRG-BN012）正在进行中（NCT05438212）。版权所有 © 2023。Elsevier公司出版。

Preoperative radiosurgery (SRS) is a feasible alternative to postoperative SRS for resected brain metastases (BM). Most reported studies of preoperative SRS utilized single fraction SRS (SF-SRS). The goal of this study was to compare outcomes and toxicity of preoperative SF-SRS with multifraction (3-5 fractions) SRS (MF-SRS) in a large international multicenter cohort (XXX).Patients with BM from solid cancers, of which at least 1 lesion was treated with preoperative SRS followed by planned resection were included from 8 institutions. SRS to synchronous intact BM was allowed. Exclusion criteria included prior or planned whole brain radiotherapy. Intracranial outcomes were estimated using cumulative incidence with competing risk of death. Propensity score matched (PSM) analyses were performed.The study cohort included 404 patients with 416 resected index lesions, of which SF-SRS and MF-SRS was used for 317 (78.5%) and 87 patients (21.5%), respectively. Median dose was 15 Gy in 1 fraction for SF-SRS and 24 Gy in 3 fractions for MF-SRS. Univariable analysis demonstrated that SF-SRS was associated with higher cavity local recurrence (LR) compared with MF-SRS (2-year: 16.3% vs. 2.9%, p=0.004), which was also demonstrated in multivariable analysis. PSM yielded 81 matched pairs (n=162). PSM analysis also demonstrated significantly higher rate of cavity LR with SF-SRS (2-year: 19.8% vs 3.3%, p=0.003). There was no difference in adverse radiation effect (ARE), meningeal disease (MD), or overall survival (OS) between cohorts in either analysis.Preoperative MF-SRS was associated with significantly reduced risk of cavity LR in both the unmatched and PSM analyses. There was no difference in ARE, MD, or OS based on fractionation. MF-SRS may be a preferred option for neoadjuvant RT of resected brain metastases. Additional confirmatory studies are needed. A phase III randomized trial of single fraction preoperative vs. postoperative SRS (NRG-BN012) is ongoing (NCT05438212).Copyright © 2023. Published by Elsevier Inc.