Systematic review reports excellent local control with intraoperative radiotherapy in brain metastases, suggesting a rapid transition to subsequent cancer treatments.
BACKGROUND In recent years, intraoperative radiotherapy (IORT) with low-energy X-rays is emerging as an alternative to postoperative stereotactic radiotherapy (SRT) of the resection cavity in patients with resectable brain metastases (BMs). MATERIAL AND METHODS We performed a systematic review of the MEDLINE, Embase, and Scopus databases, including all original articles on IORT for resectable BMs from 2015−2025. Data on safety, local control, and survival outcomes were collected. RESULTS Ten records (5 prospective single-arm trials) were included, representing 261 patients (49% lung primary) with a median follow-up (range) of 14 (0−79) months. 77% of patients had a solitary BM at the time of surgery and IORT. The median applicator size was 2.0 cm and the median prescribed dose (range) 22.3 (20−30) Gy. The 1-year local control rate was 93% and the 1-year distant brain control rate 48%. Median overall survival was 19 months. Only 6% of patients developed leptomeningeal disease and the cumulative rate of radiation necrosis was 2.6% (grade 1 in 56% of cases). The median time to next treatment (range) was 31 (1−136) days. This was significantly shorter compared to SRT control collectives. CONCLUSION IORT for patients with BMs has a favorable toxicity profile and yields excellent local control. A potential advantage is the rapid completion of interdisciplinary BM treatment, allowing a swift transition to subsequent cancer treatments. A planned registry and a prospective randomized phase 3 trial will establish the preferred radiotherapy modality in the context of resectable BMs.
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Dejonckheere et al. (2025) studied this question.
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