Trial reportNeuro-oncology2025
Stereotactic radiosurgery for 1-10 brain metastases to avoid whole-brain radiotherapy: Results of the CYBER-SPACE randomized phase 2 trial.
Trial report in Neuro-oncology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers.
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Who cites it
14 citing papers in PubMed.
- Hypofractionated stereotactic radiotherapy versus whole-brain radiotherapy following brain metastasis resection: Results of the ESTRON randomized phase 2 trial.Neuro-oncology · 2025Trial
- Dose selection and clinical decision-making after Gamma Knife surgery for large brain metastases: implications for early identification of true progression.Journal of neuro-oncology · 2026Observational
- Boron neutron capture therapy prolongs survival in a rat model of multifocal brain metastases.Journal of neuro-oncology · 2026Article
- Anlotinib plus whole-brain radiotherapy for NSCLC brain metastases: a prospective, non-randomized, single-center cohort study.Scientific reports · 2026Article
- Clinical experience with a same-day simulation and treatment program for stereotactic radiation therapy on a C-arm linac.Journal of applied clinical medical physics · 2026Article
- Crosstalk in the brain tumor microenvironment: mechanisms, therapeutic strategies, and clinical advances.Military Medical Research · 2026Review
- Association between radiotherapy timing and intracranial outcomes in EGFR-mutant NSCLC with brain metastases treated with EGFR-TKIs.Frontiers in oncology · 2026Article
- Paradigm shift in patients with multiple brain metastases from whole brain radiotherapy to high precision multimodality treatment including stereotactic radiotherapy.Journal of neuro-oncology · 2025Article
- Oncological value of MRI in brain metastasis: exploring the potential of combining post-contrast T1 TSE (SPACE) and T1 GRE (MPRAGE) for stereotactic radiosurgery planning and surveillance.Journal of neuro-oncology · 2025Article
- Tailored radiotherapy for brain metastases improves precision and outcomes.Discover oncology · 2025Review
- Review
- Stereotactic radiosurgery for patients with brain metastases: current principles, expanding indications and opportunities for multidisciplinary care.Nature reviews. Clinical oncology · 2025Review
- Efficacy of 3D-TSE sequence-based radiosurgery in prolonging time to distant intracranial failure: A session-wise analysis in a histology-diverse patient cohort.Neuro-oncology · 2025Article
- Enhancing deep learning methods for brain metastasis detection through cross-technique annotations on SPACE MRI.European radiology experimental · 2025Article
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Authors and funding
22 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundStereotactic radiosurgery (SRS) is an emerging alternative to whole-brain radiotherapy (WBRT) for treating multiple brain metastases (BM), reducing toxicity, and improving tumor control. The CYBER-SPACE trial compared SRS based on either SPACE or MPRAGE MRI sequence for avoiding or delaying WBRT in patients with 1-10 BM.
methodsPatients with 1-10 untreated BM were randomized 1:1 to receive SRS of all lesions based on either SPACE or MPRAGE MRI sequences. If subsequently new BM occurred, SRS was repeated. WBRT was indicated upon occurrence of >10 new BM, leptomeningeal disease, or exhausted SRS-radiotolerance. The primary outcome was freedom from WBRT indication (WBRTi). Secondary outcomes included overall survival (OS), safety, and quality of life.
resultsA total of 202 patients were randomized; SPACE n = 99, MPRAGE n = 103. Twelve-month WBRTi-free survival was 77.1% (95% CI: 69.5%-83.1%) overall, 78.5% (95% CI: 66.7%-86.5%) for SPACE, and 76.0% (95% CI: 65.2%-83.9%) for MPRAGE (hazard ratio [HR] = 0.84, 95% CI: 0.43-1.63, P = .590). Patients with 5-10 BM had shorter WBRTi-free survival (HR = 3.13, 95% CI: 1.53-6.40, P = .002). Median OS was 13.1 months overall, 10.5 months for SPACE, and 15.2 months for MPRAGE (HR = 1.10, 95% CI: 0.78-1.56, P = .585). Neurologic death rate was 10.1%. Predictors for longer OS included Karnofsky Performance Status >80% (HR = 0.51, 95% CI: 0.33-0.77, P = .002) and concurrent immunotherapy (HR = 0.34, 95% CI: 0.23-0.52, P < .001).
conclusionsThe more sensitive SPACE sequence did not improve outcomes over MPRAGE. SRS with thorough monitoring and immediate re-treatment for new lesions decreases the need for WBRT and achieves low neurologic death rates. SRS should be considered a favorable alternative to WBRT for patients with 1-10 BM.
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