Abstract
We read the Letter to the Editor titled “Does early adjuvant brain metastasis SRS increase mortality?” and we are grateful for the thoughtful analysis by Dr. Moss on this intriguing topic. We agree with the author that more robust data will be necessary for driving meaningful changes to management algorithms; however, our manuscript1 in conjunction with Bander et al.’s manuscript,2 and others open the door for discussion to whether there is indeed an optimal adjuvant radiation window in the setting of brain metastasis. Our discussion addresses some possible mechanisms associated with early postoperative brain radiation complications, such as “Increased time from surgery allows for more contraction (of the resection cavity), which leads to a decrease in the volume of normal tissue being irradiated, and therefore reduced risk of symptomatic radiation necrosis.” 3 Additionally, “Another study observed a significant volume reduction for larger tumors during the intermediate phase of 22–42 days postoperatively.4 The authors cautioned not to treat any cavities in intervals earlier than 21 days after surgery due to the risk of irradiating more normal tissue.” 4 Another mechanistic hypothesis states hypoxia and edema of the surgical bed from recent resection may diminish the radiosensitivity of the targeted tumor bed.5
Published Version
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