{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T11:50:41Z","timestamp":1791546641817,"version":"4.3.4"},"reference-count":35,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T00:00:00Z","timestamp":1786492800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,10,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Advances in chemotherapy and radiotherapy have expanded indications for stereotactic radiosurgery\/radiotherapy (SRS\/SRT) for multiple brain metastases. We introduced the Elements Multiple Brain Mets System (mSRS\/SRT system), using the dynamic conformal arc method with a single isocenter, for treatment of multiple brain metastases with SRS\/SRT (mSRS\/SRT). This study analyzed outcomes of mSRS\/SRT. From December 2018 to March 2023, 29 patients (130 lesions) were treated using the mSRS\/SRT system. The prescribed dose for the planning target volume, determined by D95%, was 21 or 18\u00a0Gy in a single fraction for a tumor diameter \u22642\u00a0cm and 27\u00a0Gy in 3 fractions or 35\u00a0Gy in 5 fractions for a tumor diameter &amp;gt;2\u00a0cm. Median follow-up time was 7.2\u00a0months. The 12-month overall survival rate was 48.5%, and systemic therapy after mSRS\/SRT was associated with better overall survival. The 12-month lesion-based local recurrence rate was 14.4%, and larger tumor diameter was associated with poorer local control, whereas systemic therapy after mSRS\/SRT was associated with better local control. The 12-month intracranial control rate was 43.6%, and non-lung primary tumors, a greater number of lesions, and systemic therapy before mSRS\/SRT were associated with poorer intracranial control. Acute adverse events included 4 cases of Grade 1 headache, one of Grade 1 nausea, and one of Grade 2 alopecia. Brain necrosis was observed in 9 patients (13 lesions), and all cases were asymptomatic. These results suggest that the mSRS\/SRT system may become a treatment option for multiple brain metastases, although further evaluation is needed.<\/jats:p>","DOI":"10.1093\/jrr\/rrag064","type":"journal-article","created":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T11:52:29Z","timestamp":1783597949000},"page":"820-828","source":"Crossref","is-referenced-by-count":0,"title":["LINAC-based single-isocenter stereotactic radiotherapy for multiple brain metastases"],"prefix":"10.1093","volume":"67","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8127-254X","authenticated-orcid":false,"given":"Hikaru","family":"Niitsu","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology, Ibaraki Prefectural Central Hospital, Ibaraki Cancer Center , Kasama, 309-1793 ,","place":["Japan"]},{"name":"Department of Radiation Oncology, Faculty of Medicine, University of Tsukuba , Tsukuba, 305-8576 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6585-243X","authenticated-orcid":false,"given":"Yoshio","family":"Tamaki","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Ibaraki Prefectural Central Hospital, Ibaraki Cancer Center , Kasama, 309-1793 ,","place":["Japan"]},{"name":"Department of Radiation Oncology, Fukushima Rosai Hospital , Iwaki, 973-8403 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4040-0127","authenticated-orcid":false,"given":"Yuichi","family":"Hiroshima","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Ibaraki Prefectural Central Hospital, Ibaraki Cancer Center , Kasama, 309-1793 ,","place":["Japan"]},{"name":"Department of Radiation Oncology, Faculty of Medicine, University of Tsukuba , Tsukuba, 305-8576 ,","place":["Japan"]},{"name":"Department of Radiation Oncology, National Cancer Center Hospital East , Chiba, 277-8577 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Motohiro","family":"Murakami","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Ibaraki Prefectural Central Hospital, Ibaraki Cancer Center , Kasama, 309-1793 ,","place":["Japan"]},{"name":"Department of Radiation Oncology, Faculty of Medicine, University of Tsukuba , Tsukuba, 305-8576 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reiko","family":"Kanuma","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Ibaraki Prefectural Central Hospital, Ibaraki Cancer Center , Kasama, 309-1793 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5742-8794","authenticated-orcid":false,"given":"Toshiyuki","family":"Okumura","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Ibaraki Prefectural Central Hospital, Ibaraki Cancer Center , Kasama, 309-1793 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshinobu","family":"Furuyama","sequence":"additional","affiliation":[{"name":"Department of Radiation Technology, Ibaraki Prefectural Central Hospital , Kasama, 309-1793 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8491-9799","authenticated-orcid":false,"given":"Kazuya","family":"Shinoda","sequence":"additional","affiliation":[{"name":"Department of Radiation Technology, Ibaraki Prefectural Central Hospital , Kasama, 309-1793 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0576-8639","authenticated-orcid":false,"given":"Hideyuki","family":"Sakurai","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Ibaraki Prefectural Central Hospital, Ibaraki Cancer Center , Kasama, 309-1793 ,","place":["Japan"]},{"name":"Department of Radiation Oncology, Faculty of Medicine, University of Tsukuba , Tsukuba, 305-8576 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,8,12]]},"reference":[{"key":"2026100906565216000_ref1","doi-asserted-by":"publisher","first-page":"2865","DOI":"10.1200\/JCO.2004.12.149","article-title":"Incidence proportions of brain metastases in patients diagnosed (1973 to 2001) in the metropolitan Detroit cancer surveillance system","volume":"22","author":"Barnholtz-Sloan","year":"2004","journal-title":"J Clin Oncol"},{"key":"2026100906565216000_ref2","doi-asserted-by":"publisher","first-page":"481","DOI":"10.1016\/j.nec.2020.06.001","article-title":"Epidemiology of brain metastases","volume":"31","author":"Sacks","year":"2020","journal-title":"Neurosurg Clin N Am"},{"key":"2026100906565216000_ref3","article-title":"National Comprehensive Cancer Network. 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