1

Patients that have received pre-operative stereotactic radiosurgery (SRS) demonstrated

overall great rates, although there were several tumor and treatment factors that were associated

with local recurrence adverse radiation effects, meningeal disease, and overall survival.1 Clinical

trial NRG-BN012 compares the addition of radiation either before or after surgery for patients

with brain metastasis. This is a randomized phase III trial that is estimated to have 236

participants. The primary objective of this trial is to determine if local tumor progression is

within the surgical bed, adverse radiation effects are correlated to post-SRS radiation necrosis, or

nodular meningeal disease is improved in patients that were treated with SRS pre- or post-

surgery. Some of the secondary objectives include, but are not limited to the overall survival,

frequency of adverse advents and the rate of local tumor progression.2

For a patient to be enrolled into this trial, they need to meet the specific eligible and

exclusion criteria that are set. The patient must have radiographically confirmed 1-4 brain

metastasis that are located less than 5mm from the optic chiasm and outside the brainstem. They

must have either an active or known history of invasive non-central nervous system primary

cancer that is within the last three years. A patient will be excluded from eligibility if they have

leptomeningeal disease, have had prior cranial irradiation, or if they are unable to undergo an

MRI. The patient will also be excluded if they have had a history of a germ cell tumor, small cell

carcinoma, or lymphoma.2

Once the patient is enrolled in the trial, they will have a CT scan done for immobilization

and planning and an MRI that is used for target delineation. Some components of the radiation

therapy treatment include photons, an energy of 4 megavoltage or greater, and a gamma knife or

linear accelerator machine that is used for the delivery. Depending on the size of the planned

target volume the dose will range from 12-20 Gray while sparing surrounding organs at risk.2
 2

References

1. About us. RTOG Foundation Inc. Accessed July 15, 2023. https://www.rtog.org/About-

Us

2. NRG-BN012: A randomized phase IIII trial of pre-operative compared to post-operative

stereotactic radiosurgery in patients with resectable brain metastases.

ClincalTrials.gov.2022. Accessed July 15, 2023.

https://irochouston.mdanderson.org/rpc/credentialing/NRG-BN012.pdf.