Radioterapia preoperatoria en metástasis en SNC:
La radioterapia estereotáxica preoperatoria está ganando protagonismo como alternativa a la SRS postoperatoria para disminuir la recaída local y la radionecrosis.
👥 Población
• 260 pacientes
• 299 metástasis cerebrales resecadas
• Seguimiento mediano: 10,4 meses
⚙️ Tratamiento
🔹 SRS: 20 Gy × 1 (64 lesiones)
🔹 FSRT: 24 Gy/3 fr (92%) o 25 Gy/5 fr (8%) (235 lesiones)
📊 Resultados
✅ Recidiva local
• SRS: 6,3%
• FSRT: 2,6%
• HR 0,17 (IC95% 0,03–0,98)
✅ Radionecrosis ≥G2
• SRS: 6,3%
• FSRT: 9,1%
• 0% eventos G4–5
✅ Enfermedad leptomeníngea
• 4,7% en ambos grupos
✅ Supervivencia global al año
• 57%
• Sin diferencias entre estrategias (HR 1,23)
💡 Dato interesante
Las lesiones tratadas con FSRT eran significativamente mayores (GTV mediano 10 cc vs 4 cc), pero alcanzaron igual control local y toxicidad.
🎯 Conclusión
La SRS y la FSRT preoperatorias lograron excelente control local con baja toxicidad. La FSRT aparece como una alternativa especialmente atractiva para lesiones de mayor volumen, aunque aún se necesitan estudios prospectivos aleatorizados para definir si ofrece una ventaja clínica sobre la SRS en una única fracción
https://www.advancesradonc.org/article/S2452-1094(26)00125-9/fulltext
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