{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T13:19:11Z","timestamp":1787663951081,"version":"build-2736575974"},"reference-count":30,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T00:00:00Z","timestamp":1785974400000},"content-version":"vor","delay-in-days":5,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer Medicine"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Single\u2010fraction stereotactic radiosurgery (SRS) is recommended for small brain metastases (&lt;\u20092\u2009cm). However, long\u2010term outcomes accounting for competing risks\u2014particularly death, which precludes observation of local treatment failure (LTF)\u2014remain limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively analyzed cumulative incidences of LTF, defined as tumor regrowth within the planning target volume, following 18\u2009Gy single\u2010fraction SRS (July 2014\u2013December 2021) in patients with brain metastases. Patients with prior radiotherapy or surgery to the index lesion were excluded. Cumulative incidences of LTF, death without prior LTF, overall survival (OS), and progression\u2010free survival (PFS) were estimated. Outcomes were compared between radioresistant (melanoma, sarcoma, renal cell carcinoma) and radiosensitive tumors. Subdistribution hazard ratios (SDHRs) and cause\u2010specific hazard ratios (CSHRs) identified risk factors for each endpoint.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Seventy\u2010two patients (median age 62\u2009years, IQR 55\u201368) with median tumor volume 0.3\u2009cc (IQR 0.2\u20130.7) were followed for a median of 57.2\u2009months (IQR 49.3\u201385.4). Thirty\u2010three tumors were radioresistant and 39 radiosensitive. At 36\u2009months, cumulative LTF was 62% (95% CI, 42%\u201377%) versus 31% (95% CI, 17%\u201346%) in radioresistant versus radiosensitive tumors (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.011), whereas death without prior LTF was 19% (95% CI, 7%\u201334%) versus 46% (95% CI, 30%\u201361%) (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.003). OS was 42% (95% CI, 28%\u201363%) and 36% (95% CI, 24%\u201355%), and PFS was 19% (95% CI, 9%\u201340%) and 23% (95% CI, 13%\u201341%), respectively. Radioresistant histology was associated with higher LTF hazard (CSHR 3.19; SDHR 3.91) and lower hazards of death without prior LTF (CSHR 0.37; SDHR 0.24), with no significant effect on OS or PFS. The 36\u2010month cumulative incidence of radiation necrosis was 10% (95% CI, 4%\u201318%).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Local control after 18\u2009Gy SRS is poor in radioresistant brain metastases. Higher LTF incidence is amplified by lower competing mortality, highlighting the interplay between tumor biology and survival. These findings support competing risk\u2013based analyses and consideration of alternative dose\u2010escalation for high\u2010risk tumors.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/cam4.71557","type":"journal-article","created":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T10:01:56Z","timestamp":1786010516000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Up to Four\u2010Year Outcomes of Single\u2010Fraction Stereotactic Radiosurgery for Small Brain Metastases: A Competing\u2010Risk Analysis"],"prefix":"10.1002","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7435-9337","authenticated-orcid":false,"given":"Isabella","family":"Gruber","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology University Hospital Regensburg  Regensburg 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