ArticleClinical and translational radiation oncology2026
Postoperative fractionated stereotactic radiotherapy for completely resected brain metastases with 25 Gy in five fractions: A single-center retrospective study.
Article in Clinical and translational radiation oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background and purpose: Brain metastases (BM) occur in up to 40% of patients with solid tumors. Following surgical resection, postoperative radiotherapy to the resection cavity is standard of care, yet optimal dose prescription and fractionation remain uncertain. This study evaluates clinical outcomes and toxicity of a standardized postoperative fractionated stereotactic radiotherapy (fSRT) regimen. Materials and methods: This retrospective single-center study included patients treated between 2017 and 2025 with postoperative fSRT for completely resected brain metastases. All patients received 25 Gy in five fractions, prescribed to the 80% isodose line. The planning target volume (PTV) was defined as the resection cavity plus a 2-mm margin. Primary endpoints were local control (LC) and symptomatic radiation necrosis. Secondary endpoints included overall survival (OS) and intracranial progression-free survival (iPFS). Survival outcomes were estimated using the Kaplan-Meier method, and Cox regression analyses were performed to identify prognostic factors. Results: A total of 159 patients and 181 resection cavities were analyzed. The median PTV was 22.3 cc, while the median clinical target volume (CTV) measured 13.8 cc. Median follow-up was 48 months. Local control rates at 12 and 48 months were 91.8% and 89.4%, respectively. Symptomatic radiation necrosis occurred in 3.2% of patients. Median OS was 31 months, and median iPFS was 20 months. In multivariable analysis, uncontrolled extracranial disease was the only independent predictor of inferior OS (hazard ratio 2.58, p < 0.001). Conclusion: Postoperative fSRT with 5 × 5 Gy prescribed to the 80% isodose line is safe, well-tolerated, and provides durable local control after surgical tumor removal. Additional evidence is eagerly anticipated from the ongoing phase 3 trials. Trial registration: The local ethical review committee of Ludwig-Maximilians-University Munich (application number: 24-0206) approved this study. The study has been officially registered on the German Clinical Trials Register (DRKS00034150) on December 20, 2024.
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