{"doi":"10.1093/nop/npab005","title":"Durable 5-year local control for resected brain metastases with early adjuvant SRS: the effect of timing on intended-field control","abstract":"Abstract Background Adjuvant stereotactic radiosurgery (SRS) improves the local control of resected brain metastases (BrM). However, the dependency of long-term outcomes on SRS timing relative to surgery remains unclear. Methods Retrospective analysis of patients treated with metastasectomy-plus-adjuvant SRS at Memorial Sloan Kettering Cancer Center (MSK) between 2013 and 2016 was conducted. Kaplan-Meier methodology was used to describe overall survival (OS) and cumulative incidence rates were estimated by type of recurrence, accounting for death as a competing event. Recursive partitioning analysis (RPA) and competing risks regression modeling assessed prognostic variables and associated events of interest. Results Two hundred and eighty-two patients with BrM had a median OS of 1.5 years (95% CI: 1.2-2.1) from adjuvant SRS with median follow-up of 49.8 months for survivors. Local surgical recurrence, other simultaneously SRS-irradiated site recurrence, and distant central nervous system (CNS) progression rates were 14.3% (95% CI: 10.1-18.5), 4.9% (95% CI: 2.3-7.5), and 47.5% (95% CI: 41.4-53.6) at 5 years, respectively. Median time-to-adjuvant SRS (TT-SRS) was 34 days (IQR: 27-39). TT-SRS was significantly associated with surgical site recurrence rate (P = 0.0008). SRS delivered within 1 month resulted in surgical site recurrence rate of 6.1% (95% CI: 1.3-10.9) at 1-year, compared to 9.2% (95% CI: 4.9-13.6) if delivered between 1 and 2 months, or 27.3% (95% CI: 0.0-55.5) if delivered >2 months after surgery. OS was significantly lower for patients with TT-SRS >~2 months. Postoperative length of stay, discharge to a rehabilitation facility, urgent care visits, and/or disease recurrence between surgery and adjuvant SRS associated with increased TT-SRS. Conclusions Adjuvant SRS provides durable local control. However, delays in initiation of postoperative SRS can decrease its efficacy.","journal":"Neuro-Oncology Practice","year":2021,"id":164799,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":37,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.8663,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2021-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":686990,"name":"Melissa Yuan","orcid":"0000-0002-5097-110X","position":1,"is_corresponding":false},{"id":288021,"name":"Anne S. Reiner","orcid":"0000-0002-1258-6112","position":2,"is_corresponding":false},{"id":316498,"name":"Katherine S. Panageas","orcid":"0000-0002-6591-604X","position":3,"is_corresponding":false},{"id":686991,"name":"Åse Ballangrud","orcid":"0000-0001-8269-8921","position":4,"is_corresponding":false},{"id":1866,"name":"Cameron Brennan","orcid":"0000-0003-4064-8891","position":5,"is_corresponding":false},{"id":329129,"name":"Kathryn Beal","orcid":"0000-0003-0989-6723","position":6,"is_corresponding":false},{"id":302627,"name":"Viviane Tabar","orcid":"0000-0002-1284-1670","position":7,"is_corresponding":false},{"id":374896,"name":"Nelson S. Moss","orcid":"0000-0002-0930-1681","position":8,"is_corresponding":false},{"id":482569,"name":"Evan D. Bander","orcid":"0000-0003-0381-1995","position":0,"is_corresponding":true}],"reference_count":52,"raw_metadata":null,"created_at":"2026-07-18T23:45:32.226038Z","pmid":"34055375","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}