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News
Splitting radiation into multiple sessions beats single-dose treatment for large brain metastases. The first randomized phase 3 trial comparing the two approaches found fractionated stereotactic radiosurgery (SRS) improved 1-year surgical-bed control (87% vs. 81%) and boosted median overall survival by over 8 months — with no added toxicity. Experts are calling it the new standard of care.
For patients who've had a large brain metastasis surgically removed, the question of what radiation to give afterward just got a clearer answer. The Alliance A071801 trial — the first randomized phase 3 head-to-head comparison — found that fractionated stereotactic radiosurgery (SRS), delivered over 3–5 sessions, significantly outperformed single-fraction SRS on local tumor control, survival, and the need for salvage whole-brain radiation therapy (WBRT).
Presented at the ASTRO 2026 Annual Meeting in Boston, the trial enrolled 242 patients with up to four brain metastases, including at least one resected lesion ≥2 cm. Lead investigator Dr. Ayal Aizer of Mass General Brigham and Dana-Farber Cancer Institute declared fractionated SRS "the new standard of care" for this population — a sentiment echoed by ASTRO discussants.
By the Numbers:
Why it matters: This trial upgrades fractionated SRS from retrospective-data-supported practice to randomized evidence-backed standard, giving clinicians and patients a clearer, better-outcome path forward after brain metastasis surgery.
