The research question is whether a single fraction of preoperative radiosurgery can reduce the incidence of leptomeningeal disease 12 months following resection of a brain metastasis (BM) as compared with 5 fractions of postoperative stereotactic radiotherapy.
Provision of signed and dated informed consent form
Stated willingness to comply with all study procedures and availability for the duration of the study
Age ≥18
Karnofsky performance status ≥60
Radiosensitive histology: germ cell tumour, lymphoma, multiple myeloma
>10 mm midline shift, effacement of the 4th ventricle or other sign of raised intracranial pressure requiring urgent decompressive surgery
More than 4 brain metastases or the diameter of the metastasis for resection >4.0 cm.
More than 1 metastasis requiring resection
Parallel
preoperative radiosurgery
Radiationsingle fraction radiosurgery
postoperative hypofractionated stereotactic radiotherapy
Radiationfractionated stereotactic radiotherapy /radiosurgery in 1 to 6 fractions according to local standard of care
Leptomeningeal disease
time to leptomeningeal disease
Local control of the surgical cavity
No evidence of tumour recurrence on contrast-enhanced MRI
Distant brain failure
New brain metastases
Radionecrosis
Adverse radiation effects
Quality of life assessment
EORTC questionnaire core questionnaire QLQ30, EORTC questionnaire brain module BN 20 (1-4, low scores reflect better QoL)
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