{"id":912993,"date":"2026-09-28T16:16:47","date_gmt":"2026-09-28T16:16:47","guid":{"rendered":"https:\/\/www.newsbeep.com\/ca\/912993\/"},"modified":"2026-09-28T16:16:47","modified_gmt":"2026-09-28T16:16:47","slug":"fractionated-srs-approach-improves-outcomes-for-patients-with-resected-large-brain-metastases","status":"publish","type":"post","link":"https:\/\/www.newsbeep.com\/ca\/912993\/","title":{"rendered":"Fractionated SRS Approach Improves Outcomes for Patients With Resected Large Brain Metastases"},"content":{"rendered":"

Fractionated stereotactic\u00a0radiosurgery after resection improves surgical bed control compared with single-fraction stereotactic radiosurgery for patients with large brain metastases,\u00a0according to findings from a phase III trial presented at the 2026 American Society for Radiation Oncology (ASTRO) Annual Meeting (Abstract LBA 01<\/a>).\u00a0<\/p>\n

\u201cThis study moves fractionated radiosurgery from a reasonable practice supported by retrospective data to one backed by a randomized phase III trial,\u201d said study co-author Ayal A. Aizer, MD,\u00a0a radiation oncologist at Mass General Brigham\/Dana-Farber Cancer Institute in Boston. \u201cWe now have the strongest evidence to date that three to five sessions should be considered a standard postoperative treatment for patients with larger brain metastases.\u201d<\/p>\n

Background and Study Methods\u00a0<\/p>\n

Local control of brain metastases from single-fraction stereotactic radiosurgery decreases with increasing size, but fractionated radiosurgery could offer more control for larger surgical cavities.\u00a0<\/p>\n

The multicenter phase III Alliance A071801 trial enrolled 242 patients with one to four brain metastases to randomly receive either single-fraction stereotactic radiosurgery (at 12 to 20 Gy by volume) or fractionated stereotactic radiosurgery (at 27 Gy in three sessions at less than 30 cc or 30 Gy in five sessions at 30 cc or more) to intact metastases. All patients had undergone surgical resection of one lesion 2 cm or larger. Patients were stratified by age below or above 60 years, planned use of targeted therapy or immunotherapy within 4 weeks of radiotherapy, and maximal diameter of the resection cavity below or above 3 cm.\u00a0<\/p>\n

\u201cAfter surgery for a large brain metastasis, the challenge is giving enough radiation therapy to eliminate microscopic cancer cells left behind without exposing too much healthy brain to a high single dose,\u201d said principal investigator Paul D. Brown, MD, the Wilmeth Professor of Radiation Oncology at the Mayo Clinic in Rochester, Minnesota. \u201cDividing the radiation dose over several treatments gives healthy tissue time to recover between doses while still delivering an effective dose to the treatment area. By fractionating the treatment, we were able to improve local control while maintaining a similar safety profile.\u201d<\/p>\n

The primary study endpoint was time to surgical bed failure. Secondary endpoints included local control of intact brain metastases, overall survival, and radiation necrosis rates.\u00a0<\/p>\n

Key Findings\u00a0<\/p>\n

Patients were followed for a median of 48 months.\u00a0<\/p>\n

Surgical bed control was significantly improved in the fractionated arm compared with the single-fraction arm, with 1-year rates of 87% vs 81%, respectively (P\u00a0=\u00a0.046).\u00a0 The rate of failure in treated, unresected brain metastases was lower in the fractionated arm vs the single-fraction arm at 4% vs 11%, although the difference was not considered statistically significant.\u00a0<\/p>\n

Overall survival was extended with fractionated radiotherapy at a median overall survival of 29 months in the fractionated arm vs 20 months in the single-fraction arm (stratified Cox hazard ratio [HR] = 0.69;\u00a0P\u00a0= .035). Multivariable analysis including other baseline variables observed similar associations between the study arms in terms of overall survival (HR = 0.68;\u00a0P\u00a0= .032).\u00a0<\/p>\n

Toxicity rates were similar between the two arms. The rate of grade 1 or higher radiation necrosis was 14% in the fractionated arm vs 10% in the single-fraction arm, and the rates of cerebral edema were 8% and 9%, respectively.\u00a0<\/p>\n

\u201cWe were pleased to see better control at the surgical site because that finding aligns closely with the retrospective evidence that led us to undertake this trial,\u201d Dr. Brown said. \u201cBut the survival difference was surprising, and we cannot say with certainty why it occurred. As modern treatments help patients live longer with cancer, maintaining control of disease in the brain may play an increasingly important role in long-term outcomes.\u201d<\/p>\n

The study authors noted that since the study was not designed to determine the cause of the survival difference, more research is still needed.\u00a0<\/p>\n

\u201cWith brain metastases, large surgical\u00a0cavities present a challenge because we\u00a0have been limited in the amount of radiation\u00a0we can safely deliver in a single radiosurgery\u00a0treatment. Treating larger cavities was\u00a0associated with more side effects at higher\u00a0doses and worse local control at lower\u00a0doses. Many clinicians have already moved\u00a0toward a fractionated radiosurgery approach\u00a0based on retrospective studies, and this trial gives us randomized evidence that the\u00a0additional visits translate into a meaningful\u00a0improvement in local control without a\u00a0significant increase in side effects,\u201d said ASTRO expert Lia\u00a0Halasz, MD, FASTRO, Chair of the ASTRO\u00a0CNS Resource Panel and a radiation oncologist at the Fred Hutch Cancer Center\u00a0and University of Washington in Seattle.<\/p>\n

DISCLOSURES: For full disclosures of the study authors, visit elsevierdigitaledition.com<\/a>.<\/p>\n","protected":false},"excerpt":{"rendered":"Fractionated stereotactic\u00a0radiosurgery after resection improves surgical bed control compared with single-fraction stereotactic radiosurgery for patients with large brain…\n","protected":false},"author":2,"featured_media":912994,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[10],"tags":[49,48,84],"class_list":["post-912993","post","type-post","status-publish","format-standard","has-post-thumbnail","category-health","tag-ca","tag-canada","tag-health"],"_links":{"self":[{"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/posts\/912993","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/comments?post=912993"}],"version-history":[{"count":0,"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/posts\/912993\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/media\/912994"}],"wp:attachment":[{"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/media?parent=912993"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/categories?post=912993"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/tags?post=912993"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}