{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,9]],"date-time":"2026-11-09T10:25:16Z","timestamp":1794219916476,"version":"4.8.0"},"reference-count":44,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,9,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Managing large posterior fossa brain metastases (PFBMs) poses significant challenges. Although staged stereotactic radiosurgery (SRS) is an effective and minimally invasive alternative for large brain metastases, its clinical utility for large PFBMs has not yet been fully elucidated. The aim of this study was to evaluate the safety and efficacy of staged SRS in the treatment of large PFBMs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>This retrospective analysis included patients who underwent upfront staged SRS for PFBMs measuring 4 mL or larger between 2010 and 2024 at a single tertiary cancer center. Patients who had received prior local treatment were excluded from the study. The radiosurgical protocol encompassed delivering 24\u201330 Gy in 2 fractions, with a time interval of 3\u20134 weeks between sessions. Outcome measures, including overall survival, local control of large PFBMs, and leptomeningeal metastasis (LM), were assessed using time-dependent analyses, considering competing events when appropriate.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>A consecutive cohort of 92 patients (49 male, median age 68 years) with 96 large PFBMs was included in the study. Primary cancers were small cell lung cancer, non\u2013small cell lung cancer, and colorectal, breast, genitourinary, and upper digestive tract cancers in 11, 30, 24, 16, 7, and 4 patients, respectively. Eighty-two patients (89%) exhibited neurological symptoms, and the median volume of large PFBMs was 9.0 mL. At the time of the second session, the median PFBM volume had decreased by 49% to 4.6 mL. During the treatment interval, 2 patients underwent urgent craniotomies due to tumor bleeding and obstructive hydrocephalus. The 1- and 2-year overall survival rates following staged SRS were 51% and 30%, respectively (median 12.2 months). The 1- and 2-year local failure rates for large PFBMs were 17% and 23%, respectively. Rapid tumor response (defined as a 50% or greater volume reduction at the second session) was the sole factor associated with higher probability of local tumor control (HR 0.32, 95% CI 0.12\u20130.86; p = 0.024). The mean Karnofsky Performance Status (KPS) score improved from 71 at the first SRS session to 85 at the second; the first follow-up mean KPS score was 90 (p &lt; 0.001). The 1- and 2-year LM rates remained low at 11% and 14%, respectively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>These results suggest that staged SRS is a safe and less invasive treatment option for selected patients with PFBMs larger than 4 mL, achieving reasonable local control rates and low LMs rates in the long term.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2026.1.jns252375","type":"journal-article","created":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T00:00:41Z","timestamp":1781049641000},"page":"755-764","source":"Crossref","is-referenced-by-count":0,"title":["Long-term treatment results of staged stereotactic radiosurgery for posterior fossa brain metastases with volume larger than 4 mL"],"prefix":"10.3171","volume":"145","author":[{"given":"Shoji","family":"Yomo","sequence":"first","affiliation":[{"name":"Division of Radiation Oncology, Aizawa Comprehensive Cancer Center, Aizawa Hospital, Matsumoto City, Nagano Prefecture;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takehiro","family":"Yako","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Aizawa Hospital, Matsumoto City, Nagano Prefecture;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazuo","family":"Kitazawa","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Aizawa Hospital, Matsumoto City, Nagano Prefecture;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyota","family":"Oda","sequence":"additional","affiliation":[{"name":"Division of Radiation Oncology, Aizawa Comprehensive Cancer Center, Aizawa Hospital, Matsumoto City, Nagano Prefecture;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazuhiro","family":"Oguchi","sequence":"additional","affiliation":[{"name":"Positron Imaging Center, Aizawa Hospital, Matsumoto City, Nagano Prefecture, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"11","key":"b1","series-title":"Neuro Oncol","first-page":"1511","article-title":"Incidence and prognosis of patients with brain metastases at diagnosis of systemic malignancy: a population-based study","volume":"19","author":"Cagney DN","year":"2017","unstructured":"Cagney DN, Martin AM, Catalano PJ,  Incidence and prognosis of patients with brain metastases at diagnosis of systemic malignancy: a population-based study. Neuro Oncol. 2017;19(11):1511\u20131521. doi:10.1093\/neuonc\/nox077"},{"key":"b2","series-title":"Radiother Oncol","first-page":"27","article-title":"Post-operative stereotactic radiosurgery following excision of brain metastases: a systematic review and meta-analysis","volume":"142","author":"Akanda ZZ","year":"2020","unstructured":"Akanda ZZ, Hong W, Nahavandi S, Haghighi N, Phillips C, Kok DL. Post-operative stereotactic radiosurgery following excision of brain metastases: a systematic review and meta-analysis. Radiother Oncol. 2020;142:27\u201335. doi:10.1016\/j.radonc.2019.08.024"},{"issue":"2","key":"b3","series-title":"Adv Radiat Oncol","first-page":"100644","article-title":"Leptomeningeal disease and neurologic death after surgical resection and radiosurgery for brain metastases: a multi-institutional analysis","volume":"6","author":"Prabhu RS","year":"2021","unstructured":"Prabhu RS, Turner BE, Asher AL,  Leptomeningeal disease and neurologic death after surgical resection and radiosurgery for brain metastases: a multi-institutional analysis. Adv Radiat Oncol. 2021;6(2):100644. doi:10.1016\/j.adro.2021.100644"},{"issue":"1-2","key":"b4","series-title":"J Neurooncol","first-page":"115","article-title":"Posterior fossa metastases: risk of leptomeningeal disease when treated with stereotactic radiosurgery compared to surgery","volume":"67","author":"Siomin VE","year":"2004","unstructured":"Siomin VE, Vogelbaum MA, Kanner AA, Lee SY, Suh JH, Barnett GH. Posterior fossa metastases: risk of leptomeningeal disease when treated with stereotactic radiosurgery compared to surgery. J Neurooncol. 2004;67(1-2):115\u2013121. doi:10.1023\/b:neon.0000021785.00660.2b"},{"issue":"2","key":"b5","series-title":"J Neurosurg","first-page":"248","article-title":"Comparative risk of leptomeningeal disease after resection or stereotactic radiosurgery for solid tumor metastasis to the posterior fossa","volume":"108","author":"Suki D","year":"2008","unstructured":"Suki D, Abouassi H, Patel AJ, Sawaya R, Weinberg JS, Groves MD. Comparative risk of leptomeningeal disease after resection or stereotactic radiosurgery for solid tumor metastasis to the posterior fossa. J Neurosurg. 2008;108(2):248\u2013257. doi:10.3171\/JNS\/2008\/108\/2\/0248"},{"issue":"1","key":"b6","series-title":"Neurooncol Adv","first-page":"vdab162","article-title":"Leptomeningeal disease in neurosurgical brain metastases patients: a systematic review and meta-analysis","volume":"3","author":"Tewarie IA","year":"2021","unstructured":"Tewarie IA, Jessurun CAC, Hulsbergen AFC, Smith TR, Mekary RA, Broekman MLD. Leptomeningeal disease in neurosurgical brain metastases patients: a systematic review and meta-analysis. Neurooncol Adv. 2021;3(1):vdab162. doi:10.1093\/noajnl\/vdab162"},{"issue":"9","key":"b7","series-title":"Cancers (Basel)","first-page":"1557","article-title":"Patterns of recurrence after postoperative stereotactic radiotherapy for brain metastases","volume":"17","author":"Crouzen JA","year":"2025","unstructured":"Crouzen JA, Petoukhova AL, Hakstege M,  Patterns of recurrence after postoperative stereotactic radiotherapy for brain metastases. Cancers (Basel). 2025;17(9):1557. doi:10.3390\/cancers17091557"},{"issue":"4","key":"b8","series-title":"Int J Radiat Oncol Biol Phys","first-page":"899","article-title":"A new treatment paradigm: neoadjuvant radiosurgery before surgical resection of brain metastases with analysis of local tumor recurrence","volume":"88","author":"Asher AL","year":"2014","unstructured":"Asher AL, Burri SH, Wiggins WF,  A new treatment paradigm: neoadjuvant radiosurgery before surgical resection of brain metastases with analysis of local tumor recurrence. Int J Radiat Oncol Biol Phys. 2014;88(4):899\u2013906. doi:10.1016\/j.ijrobp.2013.12.013"},{"issue":"5","key":"b9","series-title":"J Neurosurg","first-page":"1387","article-title":"Preoperative stereotactic radiosurgery before planned resection of brain metastases: updated analysis of efficacy and toxicity of a novel treatment paradigm","volume":"131","author":"Prabhu RS","year":"2019","unstructured":"Prabhu RS, Miller KR, Asher AL,  Preoperative stereotactic radiosurgery before planned resection of brain metastases: updated analysis of efficacy and toxicity of a novel treatment paradigm. J Neurosurg. 2019;131(5):1387\u20131394. doi:10.3171\/2018.7.JNS181293"},{"key":"b10","series-title":"World Neurosurg","first-page":"35","article-title":"Preoperative versus postoperative radiosurgery of brain metastases: a meta-analysis","volume":"182","author":"Dharnipragada R","year":"2024","unstructured":"Dharnipragada R, Dusenbery K, Ferreira C, Sharma M, Chen CC. Preoperative versus postoperative radiosurgery of brain metastases: a meta-analysis. World Neurosurg. 2024;182:35\u201341. doi:10.1016\/j.wneu.2023.10.131"},{"issue":"1","key":"b11","series-title":"Neurosurg Rev","first-page":"16","article-title":"Preoperative versus postoperative stereotactic radiosurgery for brain metastases: a systematic review and meta-analysis of comparative studies","volume":"48","author":"Maroufi SF","year":"2025","unstructured":"Maroufi SF, Fallahi MS, Maroufi SP, Kassaeyan V, Palmisciano P, Sheehan JP. Preoperative versus postoperative stereotactic radiosurgery for brain metastases: a systematic review and meta-analysis of comparative studies. Neurosurg Rev. 2025;48(1):16. doi:10.1007\/s10143-024-03166-6"},{"issue":"2","key":"b12","series-title":"J Neurosurg","first-page":"366","article-title":"Impact of 2-staged stereotactic radiosurgery for treatment of brain metastases >\/= 2 cm","volume":"129","author":"Angelov L","year":"2018","unstructured":"Angelov L, Mohammadi AM, Bennett EE,  Impact of 2-staged stereotactic radiosurgery for treatment of brain metastases >\/= 2 cm. J Neurosurg. 2018;129(2):366\u2013382. doi:10.3171\/2017.3.JNS162532"},{"issue":"1","key":"b13","series-title":"J Neurosurg","first-page":"227","article-title":"Comparison of treatment results between 3- and 2-stage Gamma Knife radiosurgery for large brain metastases: a retrospective multi-institutional study","volume":"131","author":"Serizawa T","year":"2019","unstructured":"Serizawa T, Higuchi Y, Yamamoto M,  Comparison of treatment results between 3- and 2-stage Gamma Knife radiosurgery for large brain metastases: a retrospective multi-institutional study. J Neurosurg. 2019;131(1):227\u2013237. doi:10.3171\/2018.4.JNS172596"},{"issue":"Suppl 2","key":"b14","series-title":"Neuro Oncol","first-page":"ii117","article-title":"INNV-03. Efficacy and long-term outcomes in the management of large brain metastasis (\u2265 4 cm3) using 2-staged stereotactic radiosurgery (2-SSRS): an international study","volume":"22","author":"Hori Y","year":"2020","unstructured":"Hori Y, Yomo S, Wei W,  INNV-03. Efficacy and long-term outcomes in the management of large brain metastasis (\u2265 4 cm3) using 2-staged stereotactic radiosurgery (2-SSRS): an international study. Neuro Oncol. 2020;22(Suppl 2):ii117. doi:10.1093\/neuonc\/noaa215.487"},{"issue":"5","key":"b15","series-title":"Clin Exp Metastasis","first-page":"415","article-title":"\u2018Sandwich treatment\u2019 for posterior fossa brain metastases with volume larger than 4cm(3): a multicentric retrospective study","volume":"40","author":"Wang Z","year":"2023","unstructured":"Wang Z, Chen H, Chen Q, Zhu Y, Li M, Jia Z. \u2018Sandwich treatment\u2019 for posterior fossa brain metastases with volume larger than 4cm(3): a multicentric retrospective study. Clin Exp Metastasis. 2023;40(5):415\u2013422. doi:10.1007\/s10585-023-10220-y"},{"issue":"1","key":"b16","series-title":"Acta Neurochir (Wien)","first-page":"100","article-title":"Is two-staged gamma knife surgery a reasonable management option for very large cerebellar metastases? A case series of three patients","volume":"166","author":"Lo YT","year":"2024","unstructured":"Lo YT, Karlsson B, Wong A, Vellayappan BA, Yeo TT, Nga VDW. Is two-staged gamma knife surgery a reasonable management option for very large cerebellar metastases? A case series of three patients. Acta Neurochir (Wien). 2024;166(1):100. doi:10.1007\/s00701-024-05974-7"},{"issue":"9596","key":"b17","series-title":"Lancet","first-page":"1453","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies","volume":"370","author":"von Elm E","year":"2007","unstructured":"von Elm E, Altman DG, Egger M, Pocock SJ, G\u00f8tzsche PC, Vandenbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet. 2007;370(9596):1453\u20131457. doi:10.1016\/S0140-6736(07)61602-X"},{"issue":"6","key":"b18","series-title":"Lancet Oncol","first-page":"e270","article-title":"Response assessment criteria for brain metastases: proposal from the RANO group","volume":"16","author":"Lin NU","year":"2015","unstructured":"Lin NU, Lee EQ, Aoyama H,  Response assessment criteria for brain metastases: proposal from the RANO group. Lancet Oncol. 2015;16(6):e270\u2013e278. doi:10.1016\/S1470-2045(15)70057-4"},{"issue":"3","key":"b19","series-title":"Neurosurgery","first-page":"486","article-title":"T1\/T2 matching to differentiate tumor growth from radiation effects after stereotactic radiosurgery","volume":"66","author":"Kano H","year":"2010","unstructured":"Kano H, Kondziolka D, Lobato-Polo J, Zorro O, Flickinger JC, Lunsford LD. T1\/T2 matching to differentiate tumor growth from radiation effects after stereotactic radiosurgery. Neurosurgery. 2010;66(3):486\u2013492. doi:10.1227\/01.NEU.0000360391.35749.A5"},{"issue":"1","key":"b20","series-title":"BMC Cancer","first-page":"713","article-title":"Prospective study of 11C-methionine PET for distinguishing between recurrent brain metastases and radiation necrosis: limitations of diagnostic accuracy and long-term results of salvage treatment","volume":"17","author":"Yomo S","year":"2017","unstructured":"Yomo S, Oguchi K. Prospective study of 11C-methionine PET for distinguishing between recurrent brain metastases and radiation necrosis: limitations of diagnostic accuracy and long-term results of salvage treatment. BMC Cancer. 2017;17(1):713. doi:10.1186\/s12885-017-3702-x"},{"issue":"3","key":"b21","series-title":"Int J Radiat Oncol Biol Phys","first-page":"537","article-title":"Surgical resection of brain metastases and the risk of leptomeningeal recurrence in patients treated with stereotactic radiosurgery","volume":"94","author":"Johnson MD","year":"2016","unstructured":"Johnson MD, Avkshtol V, Baschnagel AM,  Surgical resection of brain metastases and the risk of leptomeningeal recurrence in patients treated with stereotactic radiosurgery. Int J Radiat Oncol Biol Phys. 2016;94(3):537\u2013543. doi:10.1016\/j.ijrobp.2015.11.022"},{"issue":"8","key":"b22","series-title":"Neuro Oncol","first-page":"1049","article-title":"A multi-institutional analysis of presentation and outcomes for leptomeningeal disease recurrence after surgical resection and radiosurgery for brain metastases","volume":"21","author":"Prabhu RS","year":"2019","unstructured":"Prabhu RS, Turner BE, Asher AL,  A multi-institutional analysis of presentation and outcomes for leptomeningeal disease recurrence after surgical resection and radiosurgery for brain metastases. Neuro Oncol. 2019;21(8):1049\u20131059. doi:10.1093\/neuonc\/noz049"},{"issue":"6","key":"b23","series-title":"J Neurosurg","first-page":"1561","article-title":"Predicting leptomeningeal disease spread after resection of brain metastases using machine learning","volume":"138","author":"Tewarie IA","year":"2023","unstructured":"Tewarie IA, Senko AW, Jessurun CAC,  Predicting leptomeningeal disease spread after resection of brain metastases using machine learning. J Neurosurg. 2023;138(6):1561\u20131569. doi:10.3171\/2022.8.JNS22744"},{"issue":"12","key":"b24","series-title":"Neuro Oncol","first-page":"3224","article-title":"Hypofractionated stereotactic radiotherapy versus whole-brain radiotherapy following brain metastasis resection - results of the ESTRON randomized phase 2 trial","volume":"27","author":"El Shafie RA","year":"2025","unstructured":"El Shafie RA, Bernhardt D, Welzel T,  Hypofractionated stereotactic radiotherapy versus whole-brain radiotherapy following brain metastasis resection - results of the ESTRON randomized phase 2 trial. Neuro Oncol. 2025;27(12):3224\u20133236. doi:10.1093\/neuonc\/noaf182"},{"issue":"11","key":"b25","series-title":"Lancet Oncol","first-page":"1037","article-title":"Neurocognition in patients with brain metastases treated with radiosurgery or radiosurgery plus whole-brain irradiation: a randomised controlled trial","volume":"10","author":"Chang EL","year":"2009","unstructured":"Chang EL, Wefel JS, Hess KR,  Neurocognition in patients with brain metastases treated with radiosurgery or radiosurgery plus whole-brain irradiation: a randomised controlled trial. Lancet Oncol. 2009;10(11):1037\u20131044. doi:10.1016\/S1470-2045(09)70263-3"},{"issue":"1","key":"b26","series-title":"J Clin Oncol","first-page":"65","article-title":"A European Organisation for Research and Treatment of Cancer phase III trial of adjuvant whole-brain radiotherapy versus observation in patients with one to three brain metastases from solid tumors after surgical resection or radiosurgery: quality-of-life results","volume":"31","author":"Soffietti R","year":"2013","unstructured":"Soffietti R, Kocher M, Abacioglu UM,  A European Organisation for Research and Treatment of Cancer phase III trial of adjuvant whole-brain radiotherapy versus observation in patients with one to three brain metastases from solid tumors after surgical resection or radiosurgery: quality-of-life results. J Clin Oncol. 2013;31(1):65\u201372. doi:10.1200\/JCO.2011.41.0639"},{"issue":"4","key":"b27","series-title":"JAMA","first-page":"401","article-title":"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","volume":"316","author":"Brown PD","year":"2016","unstructured":"Brown PD, Jaeckle K, Ballman KV,  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. 2016;316(4):401\u2013409. doi:10.1001\/jama.2016.9839"},{"issue":"8","key":"b28","series-title":"Lancet Oncol","first-page":"1049","article-title":"Postoperative stereotactic radiosurgery compared with whole brain radiotherapy for resected metastatic brain disease (NCCTG N107C\/CEC.3): a multicentre, randomised, controlled, phase 3 trial","volume":"18","author":"Brown PD","year":"2017","unstructured":"Brown PD, Ballman KV, Cerhan JH,  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. 2017;18(8):1049\u20131060. doi:10.1016\/S1470-2045(17)30441-2"},{"issue":"5","key":"b29","series-title":"Int J Radiat Oncol Biol Phys","first-page":"1543","article-title":"Three-staged stereotactic radiotherapy without whole brain irradiation for large metastatic brain tumors","volume":"74","author":"Higuchi Y","year":"2009","unstructured":"Higuchi Y, Serizawa T, Nagano O,  Three-staged stereotactic radiotherapy without whole brain irradiation for large metastatic brain tumors. Int J Radiat Oncol Biol Phys. 2009;74(5):1543\u20131548. doi:10.1016\/j.ijrobp.2008.10.035"},{"issue":"1","key":"b30","series-title":"J Neurooncol","first-page":"159","article-title":"A prospective pilot study of two-session Gamma Knife surgery for large metastatic brain tumors","volume":"109","author":"Yomo S","year":"2012","unstructured":"Yomo S, Hayashi M, Nicholson C. A prospective pilot study of two-session Gamma Knife surgery for large metastatic brain tumors. J Neurooncol. 2012;109(1):159\u2013165. doi:10.1007\/s11060-012-0882-8"},{"key":"b31","series-title":"Clin Neurol Neurosurg","first-page":"106645","article-title":"Hypofractionated versus single-fraction stereotactic radiosurgery for the treatment of brain metastases: a systematic review and meta-analysis","volume":"206","author":"July J","year":"2021","unstructured":"July J, Pranata R. Hypofractionated versus single-fraction stereotactic radiosurgery for the treatment of brain metastases: a systematic review and meta-analysis. Clin Neurol Neurosurg. 2021;206:106645. doi:10.1016\/j.clineuro.2021.106645"},{"issue":"2","key":"b32","series-title":"Neurosurgery","first-page":"253","article-title":"Hypofractionated stereotactic radiosurgery in the management of brain metastases","volume":"95","author":"Lehrer EJ","year":"2024","unstructured":"Lehrer EJ, Breen WG, Singh R,  Hypofractionated stereotactic radiosurgery in the management of brain metastases. Neurosurgery. 2024;95(2):253\u2013258. doi:10.1227\/neu.0000000000002897"},{"key":"b33","series-title":"World Neurosurg","first-page":"e714","article-title":"Acute management of Gamma Knife radiosurgery for asymptomatic obstructive hydrocephalus associated with posterior fossa metastases","volume":"144","author":"Matsunaga S","year":"2020","unstructured":"Matsunaga S, Shuto T, Kobayashi N, Murata H, Yamamoto T. Acute management of Gamma Knife radiosurgery for asymptomatic obstructive hydrocephalus associated with posterior fossa metastases. World Neurosurg. 2020;144:e714\u2013e722. doi:10.1016\/j.wneu.2020.09.059"},{"issue":"2","key":"b34","series-title":"J Neurosurg","first-page":"466","article-title":"The effect of Gamma Knife radiosurgery on large posterior fossa metastases and the associated mass effect from peritumoral edema","volume":"134","author":"Muhsen BA","year":"2021","unstructured":"Muhsen BA, Joshi KC, Lee BS,  The effect of Gamma Knife radiosurgery on large posterior fossa metastases and the associated mass effect from peritumoral edema. J Neurosurg. 2021;134(2):466\u2013474. doi:10.3171\/2019.11.JNS191485"},{"issue":"11","key":"b35","series-title":"Brain Sci","first-page":"1059","article-title":"Surgical resection followed by stereotactic radiosurgery (S+SRS) versus SRS Alone for large posterior fossa brain metastases: a comparative analysis of outcomes and factors guiding treatment modality selection","volume":"14","author":"Lau R","year":"2024","unstructured":"Lau R, Gutierrez-Valencia E, Santiago A,  Surgical resection followed by stereotactic radiosurgery (S+SRS) versus SRS Alone for large posterior fossa brain metastases: a comparative analysis of outcomes and factors guiding treatment modality selection. Brain Sci. 2024;14(11):1059. doi:10.3390\/brainsci14111059"},{"issue":"1","key":"b36","series-title":"Neurosurg Rev","first-page":"418","article-title":"Upfront frameless hypofractionated gamma knife radiosurgery for large posterior fossa metastases","volume":"48","author":"Samanci Y","year":"2025","unstructured":"Samanci Y, Aydin S, D\u00fczkalir AH, Askeroglu MO, Peker S. Upfront frameless hypofractionated gamma knife radiosurgery for large posterior fossa metastases. Neurosurg Rev. 2025;48(1):418. doi:10.1007\/s10143-025-03572-4"},{"issue":"2","key":"b37","series-title":"Int J Radiat Oncol Biol Phys","first-page":"510","article-title":"A new prognostic index and comparison to three other indices for patients with brain metastases: an analysis of 1,960 patients in the RTOG database","volume":"70","author":"Sperduto PW","year":"2008","unstructured":"Sperduto PW, Berkey B, Gaspar LE, Mehta M, Curran W. A new prognostic index and comparison to three other indices for patients with brain metastases: an analysis of 1,960 patients in the RTOG database. Int J Radiat Oncol Biol Phys. 2008;70(2):510\u2013514. doi:10.1016\/j.ijrobp.2007.06.074"},{"key":"b38","series-title":"J Clin Oncol","article-title":"CNS response to osimertinib versus standard epidermal growth factor receptor tyrosine kinase inhibitors in patients with untreated EGFR-mutated advanced non-small-cell lung cancer","author":"Reungwetwattana T","unstructured":"Reungwetwattana T, Nakagawa K, Cho BC,  CNS response to osimertinib versus standard epidermal growth factor receptor tyrosine kinase inhibitors in patients with untreated EGFR-mutated advanced non-small-cell lung cancer. J Clin Oncol. Published online August 28, 2018. doi:10.1200\/JCO.2018.78.3118"},{"issue":"6","key":"b39","series-title":"J Clin Oncol","first-page":"538","article-title":"Osimertinib in patients with epidermal growth factor receptor mutation-positive non-small-cell lung cancer and leptomeningeal metastases: the BLOOM study","volume":"38","author":"Yang JCH","year":"2020","unstructured":"Yang JCH, Kim SW, Kim DW,  Osimertinib in patients with epidermal growth factor receptor mutation-positive non-small-cell lung cancer and leptomeningeal metastases: the BLOOM study. J Clin Oncol. 2020;38(6):538\u2013547. doi:10.1200\/JCO.19.00457"},{"issue":"1","key":"b40","series-title":"Neuro Oncol","first-page":"157","article-title":"Trastuzumab deruxtecan in patients with central nervous system involvement from HER2-positive breast cancer: the DEBBRAH trial","volume":"25","author":"P\u00e9rez-Garc\u00eda JM","year":"2023","unstructured":"P\u00e9rez-Garc\u00eda JM, Vaz Batista M, Cortez P,  Trastuzumab deruxtecan in patients with central nervous system involvement from HER2-positive breast cancer: the DEBBRAH trial. Neuro Oncol. 2023;25(1):157\u2013166. doi:10.1093\/neuonc\/noac144"},{"issue":"12","key":"b41","series-title":"Neuro Oncol","first-page":"2305","article-title":"Final outcome analysis from the phase II TUXEDO-1 trial of trastuzumab-deruxtecan in HER2-positive breast cancer patients with active brain metastases","volume":"26","author":"Bartsch R","year":"2024","unstructured":"Bartsch R, Berghoff AS, Furtner J,  Final outcome analysis from the phase II TUXEDO-1 trial of trastuzumab-deruxtecan in HER2-positive breast cancer patients with active brain metastases. Neuro Oncol. 2024;26(12):2305\u20132315. doi:10.1093\/neuonc\/noae123"},{"issue":"Suppl 13","key":"b42","series-title":"J Thorac Dis","first-page":"S1564","article-title":"Do immune checkpoint inhibitors need new studies methodology?","volume":"10","author":"Ferrara R","year":"2018","unstructured":"Ferrara R, Pilotto S, Caccese M,  Do immune checkpoint inhibitors need new studies methodology?. J Thorac Dis. 2018;10(Suppl 13):S1564\u2013S1580. doi:10.21037\/jtd.2018.01.131"},{"key":"b43","series-title":"Radiat Oncol","first-page":"132","article-title":"A minimally invasive treatment option for large metastatic brain tumors: long-term results of two-session Gamma Knife stereotactic radiosurgery","volume":"9","author":"Yomo S","year":"2014","unstructured":"Yomo S, Hayashi M. A minimally invasive treatment option for large metastatic brain tumors: long-term results of two-session Gamma Knife stereotactic radiosurgery. Radiat Oncol. 2014;9:132. doi:10.1186\/1748-717X-9-132"},{"key":"b44","series-title":"Radiother Oncol","first-page":"111127","article-title":"Staged Gamma Knife radiosurgery for large brain metastases: local control and the influence of systemic treatment","volume":"212","author":"Huisman RG","year":"2025","unstructured":"Huisman RG, van Schie P, Merckel LG,  Staged Gamma Knife radiosurgery for large brain metastases: local control and the influence of systemic treatment. Radiother Oncol. 2025;212:111127. doi:10.1016\/j.radonc.2025.111127"}],"container-title":["Journal of Neurosurgery"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/145\/3\/article-p755.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/145\/3\/article-p755.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/145\/3\/article-p755.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,11,9]],"date-time":"2026-11-09T09:56:47Z","timestamp":1794218207000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/145\/3\/article-p755.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,1]]},"references-count":44,"journal-issue":{"issue":"3"},"URL":"https:\/\/doi.org\/10.3171\/2026.1.jns252375","relation":{},"ISSN":["0022-3085","1933-0693"],"issn-type":[{"value":"0022-3085","type":"print"},{"value":"1933-0693","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,1]]}}}