Pre-SRS PD-1 Inhibitor Use Linked to Increased Neurological Deficits, Mortality

Malignant gliomas present a formidable challenge in neuro-oncology, with aggressive growth and a historically poor prognosis despite conventional therapies [1, 2]. The treatment landscape has expanded to include immune checkpoint inhibitors, such as programmed cell death protein 1 (PD-1) inhibitors, which activate the immune system against cancer cells [3, 2]. In parallel, stereotactic radiosurgery (SRS) provides a highly focused method of radiation for intracranial tumors [4]. While both modalities are central to modern neuro-oncology, the optimal sequence for integrating them remains a critical and unanswered clinical question [5]. Determining the correct timing is essential for maximizing therapeutic benefit while minimizing neurotoxicity and improving patient survival and neurological function [6, 7].