Multi-Dose Radiation Therapy Outperforms Single Treatment for Brain Cancer Surgery Recovery

A randomized clinical trial demonstrated that fractionated stereotactic radiosurgery delivered over multiple sessions significantly improved local tumor control compared to single-dose treatment following brain metastasis removal. One-year surgical-bed control rates improved from 81% to 87%, overall survival extended from 20.2 to 28.6 months, and fewer patients required additional whole-brain radiation therapy. These benefits were achieved without increased side effects, supporting fractionated approaches as standard post-operative care for larger brain metastases.

The trial enrolled 242 patients across multiple centers, with 223 completing evaluation for the primary outcome measure. Treatment protocols differed between groups: single-fraction patients received variable doses determined by tumor size, while fractionated patients underwent either three sessions of 27 Gray or five sessions of 30 Gray depending on lesion dimensions. Both surgical sites and any remaining untreated brain tumors received radiation as part of the post-operative protocol.

Previous research established that larger resected metastases—those measuring 2 centimeters or greater—showed particularly poor control rates when treated with single-dose radiation alone. The trial specifically targeted this population to determine whether spreading treatment across multiple sessions could overcome the limitations observed in earlier randomized studies that first established single-fraction stereotactic radiosurgery as standard care.