{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T21:21:36Z","timestamp":1785878496100,"version":"3.56.0"},"reference-count":20,"publisher":"Springer Science and Business Media LLC","issue":"2","license":[{"start":{"date-parts":[[2025,8,13]],"date-time":"2025-08-13T00:00:00Z","timestamp":1755043200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,8,13]],"date-time":"2025-08-13T00:00:00Z","timestamp":1755043200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Universit\u00e4tsklinikum Augsburg"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Neurooncol"],"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Purpose<\/jats:title>\n            <jats:p>Due to significantly lower neurocognitive toxicity, whole-brain irradiation (WBI) has largely been replaced by focal irradiation of the resection cavity following brain metastasis surgery. However, the optimal treatment modality and fractionation scheme remain controversial. This study conducts a comparative analysis of hypofractionated stereotactic radiotherapy (HSRT) and intraoperative radiotherapy (IORT), focusing on clinical outcomes and toxicity profiles.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>A retrospective cohort study was conducted, analyzing 129 patients (HSRT: 72, IORT: 57) with 137 treated cavities (HSRT: 75, IORT: 62) at the University Hospital of Augsburg (UKA) between 2013 and 2021. Baseline characteristics, oncological outcomes, incidence of radionecrosis (RN), and time to further treatment were compared.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>Radionecrosis occurred significantly less frequently in the IORT group compared to HSRT, with 1-year RN rates of 3.7% (95% CI: 0.5\u201323.5%) and 21.8% (95% CI: 11.7\u201339.2%), respectively (<jats:italic>p<\/jats:italic>\u2009=\u20090.00025). At two years, the RN rate remained substantially lower after IORT (8.5% vs. 53.2%). Notably, in patients without prior cerebral irradiation, no symptomatic RN (sRN) occurred following IORT, whereas the 2-year sRN rate in the HSRT group reached 35.5% (<jats:italic>p<\/jats:italic>\u2009=\u20090.0036). Oncological outcomes, including overall survival (OS), local control (LC), intracranial disease control, leptomeningeal dissemination (LMD), and WBI avoidance, were comparable between the two groups. However, distant brain control (DBC) at one year was higher in the HSRT group. While HSRT was initiated after a median delay of 29 days (range: 14\u201371), IORT was delivered intraoperatively, enabling immediate continuation of systemic therapy.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>In this retrospective single-center analysis, IORT demonstrated comparable oncological efficacy to HSRT while significantly reducing the risk of RN. Given its intraoperative delivery and the ability to promptly resume systemic therapy, and the precise application directly at the resection cavity, IORT may represent a practical and effective alternative in selected patients.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1007\/s11060-025-05152-4","type":"journal-article","created":{"date-parts":[[2025,8,13]],"date-time":"2025-08-13T06:49:36Z","timestamp":1755067776000},"page":"845-856","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Comparing intraoperative radiotherapy (IORT) and hypofractionated stereotactic radiotherapy (HSRT) after brain metastasis surgery: impact on oncological outcome and radionecrosis"],"prefix":"10.1007","volume":"175","author":[{"given":"Maria","family":"Neu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ehab","family":"Shiban","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philipp","family":"Krauss","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bj\u00f6rn","family":"Sommer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zoha","family":"Roushan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susanne","family":"Gutser","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoph J.","family":"Maurer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tilman","family":"Janzen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georg","family":"St\u00fcben","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0545-1367","authenticated-orcid":false,"given":"Klaus-Henning","family":"Kahl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,8,13]]},"reference":[{"issue":"11","key":"5152_CR1","doi-asserted-by":"publisher","first-page":"1611","DOI":"10.1016\/0360-3016(87)90154-4","volume":"13","author":"SR Smalley","year":"1987","unstructured":"Smalley SR et al (1987) Adjuvant radiation therapy after surgical resection of solitary brain metastasis: association with pattern of failure and survival. Int J Radiat Oncol Biol Phys 13(11):1611\u20131616","journal-title":"Int J Radiat Oncol Biol Phys"},{"issue":"17","key":"5152_CR2","doi-asserted-by":"publisher","first-page":"1485","DOI":"10.1001\/jama.280.17.1485","volume":"280","author":"RA Patchell","year":"1998","unstructured":"Patchell RA et al (1998) Postoperative radiotherapy in the treatment of single metastases to the brain: a randomized trial. JAMA 280(17):1485\u20131489","journal-title":"JAMA"},{"issue":"12","key":"5152_CR3","doi-asserted-by":"publisher","first-page":"1124","DOI":"10.1007\/s00066-021-01831-z","volume":"197","author":"KH Kahl","year":"2021","unstructured":"Kahl KH et al (2021) Intraoperative radiotherapy with low-energy x-rays after neurosurgical resection of brain metastases-an Augsburg university medical center experience. Strahlenther Onkol 197(12):1124\u20131130","journal-title":"Strahlenther Onkol"},{"issue":"1","key":"5152_CR4","doi-asserted-by":"publisher","first-page":"187","DOI":"10.1007\/s11060-024-04691-6","volume":"169","author":"KH Kahl","year":"2024","unstructured":"Kahl KH et al (2024) Intraoperative radiotherapy after neurosurgical resection of brain metastases as institutional standard treatment- update of the oncological outcome form a single center cohort after 117 procedures. J Neurooncol 169(1):187\u2013193","journal-title":"J Neurooncol"},{"issue":"4","key":"5152_CR5","doi-asserted-by":"publisher","first-page":"825","DOI":"10.3171\/2014.11.JNS1449","volume":"122","author":"RJ Weil","year":"2015","unstructured":"Weil RJ et al (2015) Intraoperative radiotherapy to treat newly diagnosed solitary brain metastasis: initial experience and long-term outcomes. J Neurosurg 122(4):825\u2013832","journal-title":"J Neurosurg"},{"issue":"2","key":"5152_CR6","doi-asserted-by":"publisher","first-page":"391","DOI":"10.1007\/s11060-019-03309-6","volume":"145","author":"CP Cifarelli","year":"2019","unstructured":"Cifarelli CP et al (2019) Intraoperative radiotherapy (IORT) for surgically resected brain metastases: outcome analysis of an international cooperative study. J Neurooncol 145(2):391\u2013397","journal-title":"J Neurooncol"},{"issue":"4","key":"5152_CR7","doi-asserted-by":"publisher","first-page":"745","DOI":"10.1016\/S0360-3016(96)00619-0","volume":"37","author":"L Gaspar","year":"1997","unstructured":"Gaspar L et al (1997) Recursive partitioning analysis (RPA) of prognostic factors in three radiation therapy oncology group (RTOG) brain metastases trials. Int J Radiat Oncol Biol Phys 37(4):745\u2013751","journal-title":"Int J Radiat Oncol Biol Phys"},{"issue":"1","key":"5152_CR8","doi-asserted-by":"publisher","first-page":"107","DOI":"10.1007\/s11060-023-04380-w","volume":"164","author":"JP Layer","year":"2023","unstructured":"Layer JP et al (2023) Outcome assessment of intraoperative radiotherapy for brain metastases: results of a prospective observational study with comparative matched-pair analysis. J Neurooncol 164(1):107\u2013116","journal-title":"J Neurooncol"},{"issue":"1","key":"5152_CR9","doi-asserted-by":"publisher","first-page":"211","DOI":"10.1007\/s11060-023-04266-x","volume":"162","author":"DG de Castro","year":"2023","unstructured":"de Castro DG et al (2023) Intraoperative radiotherapy for brain metastases: first-stage results of a single-arm, open-label, phase 2 trial. J Neurooncol 162(1):211\u2013215","journal-title":"J Neurooncol"},{"issue":"8","key":"5152_CR10","doi-asserted-by":"publisher","first-page":"1040","DOI":"10.1016\/S1470-2045(17)30414-X","volume":"18","author":"A Mahajan","year":"2017","unstructured":"Mahajan A et al (2017) Post-operative stereotactic radiosurgery versus observation for completely resected brain metastases: a single-centre, randomised, controlled, phase 3 trial. Lancet Oncol 18(8):1040\u20131048","journal-title":"Lancet Oncol"},{"issue":"8","key":"5152_CR11","doi-asserted-by":"publisher","first-page":"1049","DOI":"10.1016\/S1470-2045(17)30441-2","volume":"18","author":"PD Brown","year":"2017","unstructured":"Brown PD et al (2017) Postoperative stereotactic radiosurgery compared with whole brain radiotherapy for resected metastatic brain disease (NCCTG N107C\/CEC\u00b73): a multicentre, randomised, controlled, phase 3 trial. Lancet Oncol 18(8):1049\u20131060","journal-title":"Lancet Oncol"},{"issue":"12","key":"5152_CR12","doi-asserted-by":"publisher","first-page":"1901","DOI":"10.1001\/jamaoncol.2020.4630","volume":"6","author":"KA Eitz","year":"2020","unstructured":"Eitz KA et al (2020) Multi-institutional analysis of prognostic factors and outcomes after hypofractionated stereotactic radiotherapy to the resection cavity in patients with brain metastases. JAMA Oncol 6(12):1901\u20131909","journal-title":"JAMA Oncol"},{"issue":"1","key":"5152_CR13","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1016\/j.canrad.2016.06.010","volume":"21","author":"M Dor\u00e9","year":"2017","unstructured":"Dor\u00e9 M et al (2017) Stereotactic radiotherapy following surgery for brain metastasis: predictive factors for local control and radionecrosis. Cancer Radiother 21(1):4\u20139","journal-title":"Cancer Radiother"},{"issue":"9","key":"5152_CR14","first-page":"1041","volume":"16","author":"A Sturdza","year":"2008","unstructured":"Sturdza A et al (2008) The use and toxicity of steroids in the management of patients with brain metastases. Support Care Cancer 16(9):1041\u20131048","journal-title":"Support Care Cancer"},{"issue":"12","key":"5152_CR15","first-page":"3979","volume":"26","author":"Y Hatano","year":"2018","unstructured":"Hatano Y et al (2018) Side effects of corticosteroids in patients with advanced cancer: a systematic review. Support Care Cancer 26(12):3979\u20133983","journal-title":"Support Care Cancer"},{"key":"5152_CR16","doi-asserted-by":"crossref","unstructured":"Chung C, Bryant A, Brown PD (2018) Interventions for the treatment of brain radionecrosis after radiotherapy or radiosurgery. Cochrane Database Syst Rev, 7(7):p.Cd011492.","DOI":"10.1002\/14651858.CD011492.pub2"},{"issue":"3","key":"5152_CR17","doi-asserted-by":"publisher","first-page":"683","DOI":"10.1007\/s11060-023-04464-7","volume":"164","author":"CS Dejonckheere","year":"2023","unstructured":"Dejonckheere CS et al (2023) Intraoperative or postoperative stereotactic radiotherapy for brain metastases: time to systemic treatment onset and other patient-relevant outcomes. J Neurooncol 164(3):683\u2013691","journal-title":"J Neurooncol"},{"key":"5152_CR18","doi-asserted-by":"crossref","unstructured":"Krauss P et al (2025) Intraoperative radiotherapy in brain metastasis surgery allows faster transition to systemic therapy. Neuro-Oncology Practice","DOI":"10.1093\/nop\/npaf012"},{"key":"5152_CR19","doi-asserted-by":"publisher","first-page":"147","DOI":"10.3389\/fonc.2017.00147","volume":"7","author":"C Herskind","year":"2017","unstructured":"Herskind C, Wenz F, Giordano FA (2017) Immunotherapy combined with large fractions of radiotherapy: stereotactic radiosurgery for brain Metastases-Implications for intraoperative radiotherapy after resection. Front Oncol 7:147","journal-title":"Front Oncol"},{"key":"5152_CR20","doi-asserted-by":"publisher","first-page":"992","DOI":"10.1186\/1471-2407-14-992","volume":"14","author":"FA Giordano","year":"2014","unstructured":"Giordano FA et al (2014) INTRAGO: intraoperative radiotherapy in glioblastoma multiforme\u2014a phase I\/II dose escalation study. BMC Cancer 14:992","journal-title":"BMC Cancer"}],"container-title":["Journal of Neuro-Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11060-025-05152-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s11060-025-05152-4\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11060-025-05152-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,10]],"date-time":"2025-09-10T06:58:22Z","timestamp":1757487502000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s11060-025-05152-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,13]]},"references-count":20,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2025,11]]}},"alternative-id":["5152"],"URL":"https:\/\/doi.org\/10.1007\/s11060-025-05152-4","relation":{},"ISSN":["0167-594X","1573-7373"],"issn-type":[{"value":"0167-594X","type":"print"},{"value":"1573-7373","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,13]]},"assertion":[{"value":"22 May 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"3 July 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"13 August 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The study was conducted in accordance with the Declaration of Helsinki and approved by Ethics Committee of Ludwig-Maximilians-Universit\u00e4t M\u00fcnchen (protocol code 23\u20130845; 2023-11-17).\u201d","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Informed consent was obtained from all subjects involved in the study.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"K.H.K. has received speaker honoraria and travel grants from ELEKTA AB, Varian Medical Systems, Carl Zeiss Meditec AG, AstraZeneca, Bristol Myers Squibb, MSD, Merck, Sanofi-Aventis and IcoTec.; P.K. has received speaker honoraria and travel grants from Carl Zeiss Meditec AG, Boston Scientific Corporation and Abbott Laboratories. All other authors state that they have no conflicts of interest.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}]}}