Delivering post-surgical radiation for brain metastases in several smaller doses, rather than a single session, improved tumour control and survival in a randomised phase III trial, researchers reported at the ASTRO annual meeting.

The 242-patient trial found one-year surgical-bed control of 87 per cent with fractionated radiosurgery versus 81 per cent with single-session treatment, and median overall survival of 29 months versus 20 months. Rates of side effects did not differ significantly between the groups.

Because the results were presented at a conference and are not yet published in a peer-reviewed journal, they should be considered early. The researchers suggested fractionated treatment may become a new standard if the findings hold up.

Brain metastases affect many patients with advanced cancer, and post-surgery radiation aims to stop regrowth. Patients should discuss treatment options with their oncology team; trial availability varies by centre.

Brain metastases occur in a significant share of patients with advanced lung, breast and melanoma cancers, and managing them is a central challenge in neuro-oncology. If confirmed in published results, the trial could shift practice toward multi-session radiation for larger surgical cavities.