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Fractionated Postoperative Radiosurgery Cuts Recurrence and Extends Survival for Large Brain Metastases

Randomized phase 3 data move three‑to‑five‑fraction postoperative stereotactic radiosurgery into standard consideration for larger resected cavities, prompting further study of the unexpected survival gain.

Overview

  • The Alliance A071801 phase 3 trial found three‑to‑five session postoperative stereotactic radiosurgery reduced 1‑year recurrence at the surgical cavity to 13% compared with 19% with single‑session treatment.
  • Patients in the multi‑fraction arm lived a median of about nine months longer than those in the single‑session arm, a survival difference investigators described as significant and unanticipated.
  • Safety and quality‑of‑life measures were similar between the groups, though the multi‑fraction arm had a slightly higher numeric rate of radiation necrosis (14% versus 10%).
  • The trial enrolled 242 patients between 2019 and 2022 and, after a median follow‑up of roughly 48 months, delivered the results at the ASTRO meeting in Boston on Monday, Sept. 28, 2026.
  • Clinicians say the data support adopting fractionated postoperative radiosurgery for larger cavities but note unanswered questions about why survival improved and about patient access for multi‑visit regimens.