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News
Fractionated radiosurgery beats single-dose treatment for brain metastases. A landmark phase III randomized trial (Alliance A071801) found that delivering stereotactic radiosurgery over three to five sessions after surgery significantly improved local tumor control and overall survival compared to a single dose — with no added toxicity. Experts are calling it a clear shift in the standard of care.
A first-of-its-kind phase III randomized trial has answered a long-standing question in neuro-oncology: when it comes to post-surgical radiation for large brain metastases, splitting treatment into multiple sessions is better than delivering it all at once. The Alliance A071801 trial, presented at the 2026 ASTRO Annual Meeting, enrolled 242 patients with one to four brain metastases — each with at least one surgically removed tumor ≥2 cm — and compared single-fraction stereotactic radiosurgery (SRS) against fractionated SRS (3–5 sessions).
The results were striking. Fractionated SRS improved 1-year surgical bed control and was associated with a 9-month survival advantage — all without a significant increase in side effects. The survival benefit was unexpected, since most deaths were due to systemic disease, not brain metastases, prompting researchers to explore whether better brain control may interact with modern systemic therapies to drive improved outcomes.
Why it matters: Prior evidence for fractionated SRS was limited to retrospective data. This randomized trial gives clinicians the definitive evidence needed to adopt fractionated radiosurgery as the new post-surgical standard of care for patients with larger brain metastases — improving disease control and potentially extending lives without meaningful added harm.
