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The first randomized trial comparing radiation schedules for resected brain metastases found that splitting treatment across multiple sessions beats a single dose. Patients receiving fractionated stereotactic radiosurgery (SRS) had better local tumor control and lived a median of 9 months longer. Researchers say fractionated SRS should now be considered the new standard of care.
For patients who've had a large brain metastasis surgically removed, the question of how to deliver follow-up radiation just got a clearer answer. The Alliance A071801 trial — the first randomized phase 3 study to directly compare radiation schedules — found that delivering stereotactic radiosurgery (SRS) over three to five sessions significantly outperformed the current standard of a single post-surgical dose.
The trial enrolled 242 patients with one to four brain metastases, including at least one resected tumor larger than 2 cm. Those in the fractionated SRS arm received 27–30 Gy spread across three to five sessions, while the single-fraction arm received 12–20 Gy in one visit. Results were presented at the ASTRO 2026 Annual Meeting in Boston.
By the Numbers:
Why it matters: This trial gives clinicians the randomized evidence needed to confidently shift practice. Better local control means fewer recurrences — which translates to less anxiety, fewer salvage procedures, and, unexpectedly, longer survival. Researchers are now exploring why improved brain control appears to affect overall survival outcomes.
