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Surgical resection followed by radiotherapy is a standard approach for symptomatic lesions. Intraoperative radiotherapy (IORT) enables immediate irradiation of the resection cavity and may facilitate treatment integration. We conducted a prospective phase-II-trial to evaluate the efficacy and safety of low-energy X-ray IORT following resection of brain metastases.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>INTRAMET was an open-label, single-arm study enrolling patients with suspected brain metastases between 2017 and 2022. Following resection and frozen-section confirmation of metastatic disease, IORT was delivered to the resection cavity using a mobile low-energy X-ray device. A dose of 30\u00a0Gy was prescribed to the applicator surface. Primary endpoint was local control. Secondary endpoints included distant brain control, overall survival, time to initiation of subsequent systemic therapy, and treatment-related adverse events.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Thirty-five patients were included. Median follow-up was 25.7 months. Median patient age was 64 years, and 68.6% of metastases originated from lung cancer. Local control was 94.3% (95% CI, 82.9\u201398.8%), while distant brain control was 57.1% (95% CI, 40.7\u201372.4%). Median overall survival was 43.6 months. Radionecrosis occurred in 20% of patients, predominantly low grade; no grade 4 or 5 IORT-related toxicities were observed. Leptomeningeal dissemination outside the irradiated field occurred in 8.6% of patients. Median time to initiation of subsequent systemic therapy was 45 days.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>IORT to the resection cavity was associated with favorable local control and an acceptable safety profile. It may represent a feasible alternative to postoperative stereotactic radiosurgery in selected patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s11060-026-05649-6","type":"journal-article","created":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T13:50:39Z","timestamp":1779976239000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Intraoperative radiotherapy after resection of newly diagnosed brain metastases in adult patients - results of a prospective phase II trial (INTRAMET)"],"prefix":"10.1007","volume":"178","author":[{"given":"Stefanie","family":"Brehmer","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gustavo R.","family":"Sarria","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"W\u00fcrfel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ardita","family":"Sulejmani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank","family":"Schneider","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sven","family":"Clausen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasser","family":"Abo-Madyan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arne M.","family":"Ruder","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena","family":"Sperk","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nima","family":"Etminan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank A.","family":"Giordano","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,5,28]]},"reference":[{"key":"5649_CR1","doi-asserted-by":"publisher","first-page":"481","DOI":"10.1016\/j.nec.2020.06.001","volume":"31","author":"P Sacks","year":"2020","unstructured":"Sacks P, Rahman M (2020) Epidemiology of Brain Metastases. 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All procedures were conducted in accordance with the Declaration of Helsinki.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}},{"value":"Written informed consent including consent for data publication was obtained from all individual participants included in the study.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate and publication"}},{"value":"SB reports travel expenses and honoraria from Carl Zeiss Meditec AG outside the submitted work. GRS reports consulting fees, travel expenses and honoraria from Carl Zeiss Meditec AG and member of the ASTRO international committee outside the submitted work. FS reports travel expenses and honoraria from Carl Zeiss Meditec AG outside the submitted work. SC reports travel expenses consulting fees and honoraria from Carl Zeiss Meditec AG outside the submitted work. AMR reports grants from Deutsche Arthrose-Hilfe e.V.; honoraria from Carl Zeiss Meditec AG, Astra Zeneca, Guerbet SA; participation on Data Safety Monitoring or advisory board of INTRAGO-II study and awaits decision on pending patent EP4370202A1 outside the submitted work. ES reports honoraria and travel expenses from Carl Zeiss Meditec AG and is unpaid board member (Deutsche Gesellschaft f\u00fcr Biologische Strahlenforschung). FAG reports grants or contracts from Elekta AB, TME Pharma AG, Guerbet SA, Carl Zeiss Meditec AG and Varian Medical Systems; consulting fees from Carl Zeiss Meditec AG, TME Pharma AG, Cureteq AG, Novocure and Biotex Inc; honoraria from Astra Zeneca, Medac GmbH, Carl Zeiss Meditec AG and TME Pharma AG; travel expenses from Carl Zeiss Meditec AG, TME Pharma AG, Varian Medical Systems; stocks from TME Pharma AG, receipt of other service from TME Pharma AG and holds patents EP23000076.2, EP23000075.4 and US10857388B2 outside the submitted work. The other authors report no conflicts of interest (NE, AS, SW, YA).","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"28"}}