{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T17:09:36Z","timestamp":1781284176666,"version":"3.54.1"},"reference-count":32,"publisher":"Springer Science and Business Media LLC","issue":"2","license":[{"start":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T00:00:00Z","timestamp":1774915200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.springernature.com\/gp\/researchers\/text-and-data-mining"},{"start":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T00:00:00Z","timestamp":1774915200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.springernature.com\/gp\/researchers\/text-and-data-mining"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Neurooncol"],"published-print":{"date-parts":[[2026,4]]},"DOI":"10.1007\/s11060-026-05537-z","type":"journal-article","created":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T07:12:35Z","timestamp":1774941155000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Low-energy X-ray intraoperative radiotherapy for brain metastases: a systematic review of efficacy and safety"],"prefix":"10.1007","volume":"177","author":[{"given":"Sandra","family":"Leskinen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony","family":"Coelho","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Mittelman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hannah","family":"Haile","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher P.","family":"Cifarelli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A. Gabriella","family":"Wernicke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,3,31]]},"reference":[{"issue":"1","key":"5537_CR1","doi-asserted-by":"publisher","first-page":"48","DOI":"10.1007\/s11912-011-0203-y","volume":"14","author":"L Nayak","year":"2012","unstructured":"Nayak L, Lee EQ, Wen PY (2012) Epidemiology of brain metastases. Curr Oncol Rep 14(1):48\u201354. https:\/\/doi.org\/10.1007\/s11912-011-0203-y","journal-title":"Curr Oncol Rep"},{"issue":"1","key":"5537_CR2","doi-asserted-by":"publisher","first-page":"50","DOI":"10.1007\/s11912-009-0071-x","volume":"12","author":"P Giglio","year":"2010","unstructured":"Giglio P, Gilbert MR (2010) Neurologic complications of cancer and its treatment. Curr Oncol Rep 12(1):50\u201359. https:\/\/doi.org\/10.1007\/s11912-009-0071-x","journal-title":"Curr Oncol Rep"},{"issue":"5","key":"5537_CR3","doi-asserted-by":"publisher","first-page":"483","DOI":"10.1200\/JCO.2017.75.9589","volume":"36","author":"PD Brown","year":"2018","unstructured":"Brown PD et al (2018) Whole-Brain Radiotherapy for Brain Metastases: Evolution or Revolution? J Clin Oncol 36(5):483\u2013491. https:\/\/doi.org\/10.1200\/JCO.2017.75.9589","journal-title":"J Clin Oncol"},{"issue":"12","key":"5537_CR4","doi-asserted-by":"publisher","first-page":"1809","DOI":"10.1001\/jamaoncol.2022.5049","volume":"8","author":"JD Palmer","year":"2022","unstructured":"Palmer JD et al (2022) Association of Long-term Outcomes With Stereotactic Radiosurgery vs Whole-Brain Radiotherapy for Resected Brain Metastasis: A Secondary Analysis of The N107C\/CEC.3 (Alliance for Clinical Trials in Oncology\/Canadian Cancer Trials Group) Randomized Clinical Trial. JAMA Oncol 8(12):1809\u20131815. https:\/\/doi.org\/10.1001\/jamaoncol.2022.5049","journal-title":"JAMA Oncol"},{"issue":"4","key":"5537_CR5","doi-asserted-by":"publisher","first-page":"401","DOI":"10.1001\/jama.2016.9839","volume":"316","author":"PD Brown","year":"2016","unstructured":"Brown PD et al (2016) Effect of Radiosurgery Alone vs Radiosurgery With Whole Brain Radiation Therapy on Cognitive Function in Patients With 1 to 3 Brain Metastases: A Randomized Clinical Trial. JAMA 316(4):401\u2013409. https:\/\/doi.org\/10.1001\/jama.2016.9839","journal-title":"JAMA"},{"issue":"1","key":"5537_CR6","doi-asserted-by":"publisher","first-page":"48","DOI":"10.1186\/1748-717X-6-48","volume":"6","author":"G Minniti","year":"2011","unstructured":"Minniti G et al (2011) Stereotactic radiosurgery for brain metastases: analysis of outcome and risk of brain radionecrosis. Radiat Oncol 6(1):48. https:\/\/doi.org\/10.1186\/1748-717X-6-48","journal-title":"Radiat Oncol"},{"issue":"2","key":"5537_CR7","doi-asserted-by":"publisher","first-page":"133","DOI":"10.1093\/nop\/npac007","volume":"9","author":"NK Yaghi","year":"2022","unstructured":"Yaghi NK et al (2022) Optimal timing of radiotherapy following brain metastases surgery. Neurooncol Pract 9(2):133\u2013141. https:\/\/doi.org\/10.1093\/nop\/npac007","journal-title":"Neurooncol Pract"},{"key":"5537_CR8","doi-asserted-by":"publisher","first-page":"768168","DOI":"10.3389\/fonc.2021.768168","volume":"11","author":"CP Cifarelli","year":"2021","unstructured":"Cifarelli CP, Jacobson GM (2021) Intraoperative Radiotherapy in Brain Malignancies: Indications and Outcomes in Primary and Metastatic Brain Tumors. Front Oncol 11:768168. https:\/\/doi.org\/10.3389\/fonc.2021.768168","journal-title":"Front Oncol"},{"issue":"4","key":"5537_CR9","doi-asserted-by":"publisher","first-page":"663","DOI":"10.1093\/nop\/npaf012","volume":"12","author":"P Krauss","year":"2025","unstructured":"Krauss P et al (2025) Intraoperative radiotherapy in brain metastasis surgery allows faster transition to systemic therapy. Neurooncol Pract 12(4):663\u2013669. https:\/\/doi.org\/10.1093\/nop\/npaf012","journal-title":"Neurooncol Pract"},{"issue":"5","key":"5537_CR10","doi-asserted-by":"publisher","first-page":"492","DOI":"10.1200\/JCO.21.02314","volume":"40","author":"MA Vogelbaum","year":"2022","unstructured":"Vogelbaum MA et al (2022) Treatment for Brain Metastases: ASCO-SNO-ASTRO Guideline. J Clin Oncol 40(5):492\u2013516. https:\/\/doi.org\/10.1200\/JCO.21.02314","journal-title":"J Clin Oncol"},{"issue":"4","key":"5537_CR11","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. https:\/\/doi.org\/10.3171\/2014.11.JNS1449","journal-title":"J Neurosurg"},{"key":"5537_CR12","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.jocn.2023.09.014","volume":"118","author":"P Krauss","year":"2023","unstructured":"Krauss P et al (2023) Intraoperative radiotherapy after resection of brain metastases located in the posterior fossa. Analysis of postoperative morbidity and mortality in a single center cohort. J Clin Neurosci 118:1\u20136. https:\/\/doi.org\/10.1016\/j.jocn.2023.09.014","journal-title":"J Clin Neurosci"},{"issue":"1","key":"5537_CR13","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. https:\/\/doi.org\/10.1007\/s11060-024-04691-6","journal-title":"J Neurooncol"},{"issue":"12","key":"5537_CR14","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. https:\/\/doi.org\/10.1007\/s00066-021-01831-z","journal-title":"Strahlenther Onkol"},{"key":"5537_CR15","doi-asserted-by":"publisher","unstructured":"Diehl CD et al (2023) Low-energy X-ray intraoperative radiation therapy (Lex-IORT) for resected brain metastases: a single-institution experience. Cancers 15. https:\/\/doi.org\/10.3390\/cancers15010014","DOI":"10.3390\/cancers15010014"},{"key":"5537_CR16","doi-asserted-by":"publisher","unstructured":"Hamed M et al (2022) Benchmarking safety indicators of surgical treatment of brain metastases combined with intraoperative radiotherapy: results of prospective observational study with comparative matched-pair analysis. Cancers 14. https:\/\/doi.org\/10.3390\/cancers14061515","DOI":"10.3390\/cancers14061515"},{"key":"5537_CR17","doi-asserted-by":"publisher","first-page":"111524","DOI":"10.1016\/j.jocn.2025.111524","volume":"140","author":"KJO Khu","year":"2025","unstructured":"Khu KJO et al (2025) Intraoperative radiation therapy for glioblastoma and brain metastases: Program development and initial experience from the Philippines. J Clin Neurosci 140:111524. https:\/\/doi.org\/10.1016\/j.jocn.2025.111524","journal-title":"J Clin Neurosci"},{"issue":"5","key":"5537_CR18","doi-asserted-by":"publisher","first-page":"1552","DOI":"10.1016\/j.ijrobp.2024.01.009","volume":"118","author":"JP Layer","year":"2024","unstructured":"Layer JP et al (2024) Multicentric Assessment of Safety and Efficacy of Combinatorial Adjuvant Brain Metastasis Treatment by Intraoperative Radiation Therapy and Immunotherapy. Int J Radiat Oncol Biol Phys 118(5):1552\u20131562. https:\/\/doi.org\/10.1016\/j.ijrobp.2024.01.009","journal-title":"Int J Radiat Oncol Biol Phys"},{"issue":"2","key":"5537_CR19","doi-asserted-by":"publisher","first-page":"413","DOI":"10.1007\/s11060-018-2968-4","volume":"140","author":"JA Vargo","year":"2018","unstructured":"Vargo JA et al (2018) Feasibility of dose escalation using intraoperative radiotherapy following resection of large brain metastases compared to post-operative stereotactic radiosurgery. J Neurooncol 140(2):413\u2013420. https:\/\/doi.org\/10.1007\/s11060-018-2968-4","journal-title":"J Neurooncol"},{"issue":"2","key":"5537_CR20","doi-asserted-by":"publisher","first-page":"423","DOI":"10.1007\/s11060-023-04443-y","volume":"164","author":"CP Cifarelli","year":"2023","unstructured":"Cifarelli CP et al (2023) Intracranial intraoperative radiotherapy (IORT): evaluation of electrocorticography and peri-operative seizure risk. J Neurooncol 164(2):423\u2013430. https:\/\/doi.org\/10.1007\/s11060-023-04443-y","journal-title":"J Neurooncol"},{"issue":"3","key":"5537_CR21","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. https:\/\/doi.org\/10.1007\/s11060-023-04464-7","journal-title":"J Neurooncol"},{"issue":"1","key":"5537_CR22","doi-asserted-by":"publisher","first-page":"385","DOI":"10.1007\/s10143-025-03523-z","volume":"48","author":"P Krauss","year":"2025","unstructured":"Krauss P et al (2025) Resection with intraoperative radiotherapy vs. adjuvant radiotherapy in the treatment of eloquent brain metastases: an analysis of feasibility and safety. Neurosurg Rev 48(1):385. https:\/\/doi.org\/10.1007\/s10143-025-03523-z","journal-title":"Neurosurg Rev"},{"issue":"2","key":"5537_CR23","doi-asserted-by":"publisher","first-page":"845","DOI":"10.1007\/s11060-025-05152-4","volume":"175","author":"M Neu","year":"2025","unstructured":"Neu M et al (2025) Comparing intraoperative radiotherapy (IORT) and hypofractionated stereotactic radiotherapy (HSRT) after brain metastasis surgery: impact on oncological outcome and radionecrosis. J Neurooncol 175(2):845\u2013856. https:\/\/doi.org\/10.1007\/s11060-025-05152-4","journal-title":"J Neurooncol"},{"issue":"2","key":"5537_CR24","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. https:\/\/doi.org\/10.1007\/s11060-019-03309-6","journal-title":"J Neurooncol"},{"issue":"1","key":"5537_CR25","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. https:\/\/doi.org\/10.1007\/s11060-023-04380-w","journal-title":"J Neurooncol"},{"issue":"8","key":"5537_CR26","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.3): a multicentre, randomised, controlled, phase 3 trial. Lancet Oncol 18(8):1049\u20131060. https:\/\/doi.org\/10.1016\/S1470-2045(17)30441-2","journal-title":"Lancet Oncol"},{"issue":"8","key":"5537_CR27","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. https:\/\/doi.org\/10.1016\/S1470-2045(17)30414-X","journal-title":"Lancet Oncol"},{"issue":"1","key":"5537_CR28","doi-asserted-by":"publisher","first-page":"6331","DOI":"10.1038\/s41598-020-63158-6","volume":"10","author":"JD Byrne","year":"2020","unstructured":"Byrne JD et al (2020) Post-operative radiation therapy to the surgical cavity with standard fractionation in patients with brain metastases. Sci Rep 10(1):6331. https:\/\/doi.org\/10.1038\/s41598-020-63158-6","journal-title":"Sci Rep"},{"issue":"1","key":"5537_CR29","doi-asserted-by":"publisher","first-page":"149","DOI":"10.1007\/s11060-015-1881-3","volume":"125","author":"ZA Kohutek","year":"2015","unstructured":"Kohutek ZA et al (2015) Long-term risk of radionecrosis and imaging changes after stereotactic radiosurgery for brain metastases. J Neurooncol 125(1):149\u2013156. https:\/\/doi.org\/10.1007\/s11060-015-1881-3","journal-title":"J Neurooncol"},{"issue":"3","key":"5537_CR30","doi-asserted-by":"publisher","first-page":"e267","DOI":"10.1016\/j.prro.2021.01.011","volume":"11","author":"DA Roth O\u2019Brien","year":"2021","unstructured":"Roth O\u2019Brien DA et al (2021) Timing of Adjuvant Fractionated Stereotactic Radiosurgery Affects Local Control of Resected Brain Metastases. Pract Radiat Oncol 11(3):e267\u2013e275. https:\/\/doi.org\/10.1016\/j.prro.2021.01.011","journal-title":"Pract Radiat Oncol"},{"issue":"16suppl","key":"5537_CR31","doi-asserted-by":"publisher","first-page":"2031","DOI":"10.1200\/JCO.2023.41.16_suppl.2031","volume":"41","author":"S Brehmer","year":"2023","unstructured":"Brehmer S et al (2023) Results of a prospective, single-arm, open-label phase II trial of intraoperative radiotherapy after resection of brain metastases. J Clin Oncol 41(16suppl):2031\u20132031. https:\/\/doi.org\/10.1200\/JCO.2023.41.16_suppl.2031","journal-title":"J Clin Oncol"},{"issue":"Supplement5","key":"5537_CR32","doi-asserted-by":"publisher","first-page":"v89","DOI":"10.1093\/neuonc\/noae144.298","volume":"26","author":"M Maci\u00e0 i Garau","year":"2024","unstructured":"Maci\u00e0 i Garau M et al (2024) P17.11.B Interim Analysis of a Phase Ii Trial of Intraoperative Radiotherapy (Iort) with Intrabeam after Surgical Resection of Brain Metastases (Bm) (Nct05084092). Neurooncology 26(Supplement5):v89\u2013v90. https:\/\/doi.org\/10.1093\/neuonc\/noae144.298","journal-title":"Neurooncology"}],"container-title":["Journal of Neuro-Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11060-026-05537-z.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s11060-026-05537-z","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11060-026-05537-z.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T07:16:15Z","timestamp":1778224575000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s11060-026-05537-z"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,31]]},"references-count":32,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026,4]]}},"alternative-id":["5537"],"URL":"https:\/\/doi.org\/10.1007\/s11060-026-05537-z","relation":{},"ISSN":["0167-594X","1573-7373"],"issn-type":[{"value":"0167-594X","type":"print"},{"value":"1573-7373","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,31]]},"assertion":[{"value":"11 February 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"18 March 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"31 March 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Human ethics and consent to participate"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"81"}}