128 Local Control and Adverse Radiation Events Following STaRT for Upfront Brain Metastases: Report From a Multicenter Study

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INTRODUCTION: Upfront intracranial metastases represent a relatively novel indication for the placement of collagen-embedded Cs-131 brachytherapy tiles, implanted at the time of resection, termed surgically targeted radiation therapy (STaRT). METHODS: A prospective, non-interventional registry (NCT04427384) was assessed for the first consecutive 51 patients who received STaRT for newly diagnosed metastases and were not dually enrolled in an interventional clinical trial. Patient demographics, procedure details, and adverse events were extracted and analyzed. RESULTS: Fifty-one patients with 55 treated metastases (median age 64, range 28-81) were enrolled from 11 institutions from August 2021 to May 2025. Most common primary malignancies were lung (41.2%), melanoma (15.7%), and breast (9.8%). Patients had a median of 1 metastasis (range 1-16), with 66.7% reporting a single metastasis. Average maximum diameter of treated metastases was 3.3 cm (range 1.1-5.4). Gross total resection was achieved for 90.9%. Median follow-up was 8.91 months (range 0.9-33.6) with >6 months in 21 patients. Actuarial local control was 91% at one year with local recurrence seen in 3 patients at median 23.3 months (range 0.4-26.2). Distant brain failure occurred in 11 patients at a median of 2.7 months (range 0.4-23.3). the median overall survival was 4.9 months (range 1.2-26.2). No adverse radiation events were reported. CONCLUSIONS: STaRT has shown initial success in the local control of upfront brain metastases, with a rate of 91% at one year. Although follow-up was not sufficient to make definitive statements on long-term local control, early outcomes including radiation safety were promising. Data collection and analysis is ongoing.

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