Five and done.
It’s been 3 years since we were all confused by the findings of a phase 3 trial demonstrating better local control following adjuvant whole brain radiation versus the (presumably) much more ablative single-fraction stereotactic radiosurgery (SRS) for resected brain mets. This was explained away by the fact that many patients in the SRS arm received ≤15 Gy x 1, and as low as 12 Gy x 1, which we now view as simply too low. We now have data from an international review of outcomes following adjuvant hypofractionated SRS for resected brain mets. Among 558 patients, local control at 1, 2, and 3 years was 84%, 75%, and 71%, respectively, while radionecrosis occurred in <8%, remarkably consistent with previous literature. TBL: Hypofractionated SRS for resected brain mets continues to demonstrate a favorable risk / benefit ratio. | Eitz, JAMA Oncol 2020