Neoadjuvant stereotactic radiotherapy versus upfront surgery for brain metastases
Brain metastases affect up to 30% of all cancer patients, arising most commonly from breast cancer, lung cancer, and melanoma. The treatment for brain metastases is in flux, with stereotactic radiosurgery, whole brain radiotherapy, immunotherapy, targeted therapy, chemotherapy, and intrathecal chemotherapy all considerations. While surgery is helpful to diagnose the metastasis, the metastatic disease recurs after surgery, necessitating treatment to the surgical bed with radiation. Stereotactic radiation can also be given upfront, allowing for a potential immune response to the metastasis, followed by surgery. There are ongoing clinical trials examining both strategies in patients with brain metastases, and it is possible that tumor factors such as immunogenicity, lesion size, and radiosensitivity all impact potential response. We propose a mathematical model and analysis examining both of these strategies, as well as innovative unconventional protocols, and potential approaches may include: radio-immune modeling, normal tissue complication probability modeling (i.e. Radiation necrosis), and/or agent-based modeling.