辅助立体定向放射外科 (SRS) 增强了切除脑转移瘤 (BrM) 的局部控制。然而，术后早期辅助 SRS 后局部失败 (LF) 的风险和治疗后不良放射反应 (PTRE) 的可能性尚未确定。 评估术后中位 14 天内进行辅助 SRS 是否与改善 LF 相关这项前瞻性队列研究检查了 2019 年至 2022 年实施的临床工作流程 (RapidRT)，旨在在中位 14 天内向手术患者提供 SRS，确保所有患者在术后 30 天内得到治疗。该前瞻性队列与 2013 年至 2019 年间接受 BrM 切除的历史队列 (StanRT) 进行比较，以评估 RapidRT 工作流程与 LF 和 PTRE 的关联。将 2 个队列合并起来以确定最佳 SRS 时机，幸存者的中位随访时间为 3.3 年。辅助 SRS 的时机（术后 14、21 和 30 天）。LF 和 PTRE，根据 Neuro-肿瘤脑转移标准。共有 438 名患者（265 名 [60.5%] 女性患者；23 名 [5.3%] 亚裔患者、27 名 [6.2%] 黑人患者和 364 名 [83.1%] 白人患者）平均 (SD) 年龄为 62 岁（13年; 377 人属于 StanRT 队列，61 人属于 RapidRT 队列。 RapidRT 和 StanRT 队列之间 1 年的 LF 和 PTRE 率没有显着差异。 SRS 的时机与放射学 PTRE 相关。 14天内接受放疗的患者1年PTRE率最高（18.08%；95%CI，8.31%-30.86%），22至30天内接受放疗的患者1年PTRE率最低（4.10%；95%CI，8.31%-30.86%）。 95% CI, 1.52%-8.73%; P = .03)。术后 30 天以上接受放疗的患者的 LF 率最高（10.65%；95% CI，6.90%-15.32%），但 14 天内、15 至 21 天以及 22 至 30 天内接受放疗的患者的 LF 率相当（≤14天：5.12%；95% CI，0.86%-15.60%；15至≤21天：3.21%；95% CI，0.59%-9.99%；22至≤30天：6.58%；95% CI， 3.06%-11.94%；P = .20)。在这项关于 BrM 手术切除后辅助 SRS 时机的队列研究中，辅助 SRS 的最佳时机似乎是术后 22 至 30 天内。这项研究的结果表明，这个时机可以采取平衡的方法，最大限度地减少与 LF 和 PTRE 相关的风险。

Adjuvant stereotactic radiosurgery (SRS) enhances the local control of resected brain metastases (BrM). However, the risks of local failure (LF) and potential for posttreatment adverse radiation effects (PTRE) after early postoperative adjuvant SRS have not yet been established.To evaluate whether adjuvant SRS delivered within a median of 14 days after surgery is associated with improved LF without a concomitant increase in PTRE.This prospective cohort study examines a clinical workflow (RapidRT) that was implemented from 2019 to 2022 to deliver SRS to surgical patients within a median of 14 days, ensuring all patients were treated within 30 days postoperatively. This prospective cohort was compared with a historical cohort (StanRT) of patients with BrM resected between 2013 and 2019 to assess the association of the RapidRT workflow with LF and PTRE. The 2 cohorts were combined to identify optimal SRS timing, with a median follow-up of 3.3 years for survivors.Timing of adjuvant SRS (14, 21, and 30 days postoperatively).LF and PTRE, according to modified Response Assessment in Neuro-Oncology Brain Metastases criteria.There were 438 patients (265 [60.5%] female patients; 23 [5.3%] Asian, 27 [6.2%] Black, and 364 [83.1%] White patients) with a mean (SD) age of 62 (13) years; 377 were in the StanRT cohort and 61 in the RapidRT cohort. LF and PTRE rates at 1 year were not significantly different between RapidRT and StanRT cohorts. Timing of SRS was associated with radiographic PTRE. Patients receiving radiation within 14 days had the highest 1-year PTRE rate (18.08%; 95% CI, 8.31%-30.86%), and patients receiving radiation between 22 and 30 days had the lowest 1-year PTRE rate (4.10%; 95% CI, 1.52%-8.73%; P = .03). LF rates were highest for patients receiving radiation more than 30 days from surgery (10.65%; 95% CI, 6.90%-15.32%) but comparable for patients receiving radiation within 14 days, between 15 and 21 days, and between 22 and 30 days (≤14 days: 5.12%; 95% CI, 0.86%-15.60%; 15 to ≤21 days: 3.21%; 95% CI, 0.59%-9.99%; 22 to ≤30 days: 6.58%; 95% CI, 3.06%-11.94%; P = .20).In this cohort study of adjuvant SRS timing following surgical resection of BrM, the optimal timing for adjuvant SRS appears to be within 22 to 30 days following surgery. The findings of this study suggest that this timing allows for a balanced approach that minimizes the risks associated with LF and PTRE.