{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T04:46:35Z","timestamp":1785732395634,"version":"3.56.0"},"reference-count":31,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T00:00:00Z","timestamp":1785715200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>This study aimed to evaluate and compare the efficacy of stereotactic radiosurgery (SRS) prescription doses on local control (LC) rates of brain metastases and radiation necrosis (RN) risk.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective review was conducted on patients treated between January 2018 and December 2023 at a single institution with single-fraction SRS at doses of 20 Gy, 22 Gy, or 24 Gy. The effects of radiation dose on LC and RN were evaluated using univariate analysis, then with multivariate logistic regression adjusting for gross tumor volume (GTV) and history of post-SRS whole-brain radiation therapy (WBRT).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The study included 332 brain metastases from 159 patients. 127 lesions were treated with 20 Gy (38.3%), 183 with 22 Gy (55.1%), and 22 with 24 Gy (6.6%). Median follow-up was 14 months. One-year LC rates were 96.3% for 22 Gy versus 90.1% for 20 Gy (p = 0.032). On multivariable logistic regression, 22 Gy was still associated with higher odds of 1-year LC compared with 20 Gy (adjusted OR 3.04, 95% CI 1.22\u20137.59; p = 0.017). Both SRS dose and GTV were independent predictors of RN (dose adjusted OR 2.05, p = 0.016; GTV adjusted OR 1.40 per doubling volume, p &amp;lt; 0.001). Overall survival did not differ significantly by dose (p = 0.63).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In this retrospective cohort, SRS at 22 Gy was associated with higher local control than 20 Gy. Larger GTV volumes were independently associated with a higher risk of RN. WBRT post SRS was not an independent risk factor for RN.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fonc.2026.1894130","type":"journal-article","created":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T04:27:52Z","timestamp":1785731272000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Impact of stereotactic radiosurgery dose on local control and radiation necrosis in metastatic brain lesions: a comparative study"],"prefix":"10.3389","volume":"16","author":[{"given":"Mohammad","family":"Mukahal","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology, King Hussein Cancer Center","place":["Amman, Jordan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Atef F.","family":"Hulliel","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Jordan University of Science & Technology","place":["Irbid, Jordan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam","family":"Abdallah","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, King Hussein Cancer Center","place":["Amman, Jordan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdullah","family":"Alzibdeh","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, King Hussein Cancer Center","place":["Amman, Jordan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tariq","family":"Alrawajih","sequence":"additional","affiliation":[{"name":"Primary Care, Ministry of Health","place":["Amman, Jordan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hadeel","family":"Asfour","sequence":"additional","affiliation":[{"name":"Pulmonary and Critical Care, Chicago Ridge Medical Center","place":["Chicago, IL, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ala\u2019a","family":"Khanfar","sequence":"additional","affiliation":[{"name":"Department of Research, King Hussein Cancer Center","place":["Amman, Jordan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haneen M.","family":"Suleiman","sequence":"additional","affiliation":[{"name":"Primary Care, Ministry of Health","place":["Amman, Jordan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maysa Al","family":"Hussaini","sequence":"additional","affiliation":[{"name":"Department of Pathology, King Hussein Cancer Center","place":["Amman, Jordan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nisreen","family":"Amayiri","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, King Hussein Cancer Center","place":["Amman, Jordan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad","family":"Alsmairat","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, King Hussein Cancer Center","place":["Amman, Jordan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdelatif","family":"Almousa","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, King Hussein Cancer Center","place":["Amman, Jordan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nasim","family":"Sarhan","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, King Hussein Cancer Center","place":["Amman, Jordan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shatha","family":"Abu Taha","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, King Hussein Cancer Center","place":["Amman, Jordan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmad K.H.","family":"Ibrahimi","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, King Hussein Cancer Center","place":["Amman, Jordan"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,3]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1093\/neuonc\/noad188","article-title":"The dilemma of radiation necrosis from diagnosis to treatment in the management of brain metastases","volume":"26","author":"Mayo","year":"2024","journal-title":"Neuro-oncology"},{"key":"B2","doi-asserted-by":"publisher","first-page":"Cd003869","DOI":"10.1002\/14651858.cd003869.pub3","article-title":"Whole brain radiotherapy for the treatment of newly diagnosed multiple brain metastases","volume":"1","author":"Tsao","year":"2018","journal-title":"Cochrane Database Systematic Rev"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1200\/jco.2005.04.6185","article-title":"Whole-brain radiotherapy in the management of brain metastasis","volume":"24","author":"Khuntia","year":"2006","journal-title":"J Clin Oncol"},{"key":"B4","doi-asserted-by":"publisher","first-page":"555848","DOI":"10.19080\/ctoij.2018.12.555848","article-title":"Evaluation of target volume determination for single session stereotactic radiosurgery (SRS) of brain metastases","volume":"12","author":"Demiral","year":"2018","journal-title":"Cancer Ther Oncol Int J"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1038\/nrclinonc.2011.58","article-title":"The biology of brain metastases-translation to new therapies","volume":"8","author":"Eichler","year":"2011","journal-title":"Nat Rev Clin Oncol"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2024.110540","article-title":"Local control and toxicity after stereotactic radiotherapy in brain metastases patients and the impact of novel systemic treatments","volume":"200","author":"van Schie","year":"2024","journal-title":"Radiotherapy Oncol"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.3171\/jns.2006.104.6.907","article-title":"Local control of brain metastases by stereotactic radiosurgery in relation to dose to the tumor margin","volume":"104","author":"Vogelbaum","year":"2006","journal-title":"J Neurosurg"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1016\/j.adro.2017.11.003","article-title":"Internal dose escalation is associated with increased local control for non-small cell lung cancer (NSCLC) brain metastases treated with stereotactic radiosurgery (SRS)","volume":"3","author":"Abraham","year":"2018","journal-title":"Adv Radiat Oncol"},{"key":"B9","doi-asserted-by":"publisher","first-page":"4736","DOI":"10.3390\/cancers13194736","article-title":"Risk factors for radiation necrosis in patients undergoing cranial stereotactic radiosurgery","volume":"13","author":"Kerschbaumer","year":"2021","journal-title":"Cancers"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2017.06.367","article-title":"The risk of radiation necrosis following stereotactic radiosurgery with concurrent systemic therapies","volume":"133","author":"Kim","year":"2017","journal-title":"J Neuro-Oncol"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2016.9839","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","year":"2016","journal-title":"Jama"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1016\/s1470-2045(14)71106-4","article-title":"Stereotactic radiosurgery alone for brain metastases","volume":"16","author":"Sahgal","year":"2015","journal-title":"Lancet Oncol"},{"key":"B13","doi-asserted-by":"publisher","first-page":"3728","DOI":"10.1038\/s41467-024-47998-8","article-title":"Response of treatment-naive brain metastases to stereotactic radiosurgery","volume":"15","author":"Ene","year":"2024"},{"key":"B14","first-page":"89","article-title":"Local control of brain metastases after stereotactic radiosurgery: the impact of whole brain radiotherapy and treatment paradigm","volume":"4","author":"Hughes","year":"2016","journal-title":"J Radiosurgery SBRT"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1016\/j.adro.2023.101402","article-title":"Stereotactic radiosurgery in the management of brain metastases: a case-based radiosurgery society practice guideline","volume":"9","author":"Ladbury","year":"2024","journal-title":"Adv Radiat Oncol"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.3171\/2016.3.jns153014","article-title":"Impact of the radiosurgery prescription dose on the local control of small (2 cm or smaller) brain metastases","volume":"126","author":"Mohammadi","year":"2017","journal-title":"J Neurosurg"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1016\/j.prro.2022.02.003","article-title":"Radiation therapy for brain metastases: an ASTRO clinical practice guideline","volume":"12","author":"Gondi","year":"2022","journal-title":"Pract Radiat Oncol"},{"key":"B18","doi-asserted-by":"publisher","first-page":"63","DOI":"10.1186\/s13014-015-0367-y","article-title":"Local control after radiosurgery for brain metastases: predictive factors and implications for clinical decision","volume":"10","author":"de Azevedo Santos","year":"2015","journal-title":"Radiat Oncol"},{"key":"B19","doi-asserted-by":"publisher","first-page":"53","DOI":"10.1016\/j.ijrobp.2020.10.034","article-title":"Tumor control probability of radiosurgery and fractionated stereotactic radiosurgery for brain metastases","volume":"110","author":"Redmond","year":"2021","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(04)16250-8","article-title":"Whole brain radiation therapy with or without stereotactic radiosurgery boost for patients with one to three brain metastases: phase III results of the RTOG 9508 randomised trial","volume":"363","author":"Andrews","year":"2004","journal-title":"Lancet (London England)"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1227\/neu.0000000000002456","article-title":"Local control and survival outcomes after stereotactic radiosurgery for brain metastases from gastrointestinal primaries: an international multicenter analysis","volume":"93","author":"Singh","year":"2023","journal-title":"Neurosurgery"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.3171\/2022.10.jns221900","article-title":"Stereotactic radiosurgery and local control of brain metastases from triple-negative breast cancer","volume":"138","author":"Kowalchuk","year":"2023","journal-title":"J Neurosurg"},{"key":"B23","doi-asserted-by":"publisher","first-page":"177","DOI":"10.1186\/s12911-024-02579-z","article-title":"Factors associated with the local control of brain metastases: a systematic search and machine learning application","volume":"24","author":"Kanakarajan","year":"2024","journal-title":"BMC Med Inf Decis Making"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2015.04.032","article-title":"Competing risk analysis of neurologic versus nonneurologic death in patients undergoing radiosurgical salvage after whole-brain radiation therapy failure: who actually dies of their brain metastases","volume":"92","author":"Lucas","year":"2015","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1016\/s0360-3016(03)00568-6","article-title":"Analysis of tumor control and toxicity in patients who have survived at least one year after radiosurgery for brain metastases","volume":"57","author":"Varlotto","year":"2003","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1007\/s11060-015-1881-3","article-title":"Long-term risk of radionecrosis and imaging changes after stereotactic radiosurgery for brain metastases","volume":"125","author":"Kohutek","year":"2015","journal-title":"J Neuro-Oncol"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.3171\/2014.10.jns141610","article-title":"Adverse radiation effect after stereotactic radiosurgery for brain metastases: incidence, time course, and risk factors","volume":"123","author":"Sneed","year":"2015","journal-title":"J Neurosurg"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1016\/j.ctro.2021.01.003","article-title":"The individual risk of symptomatic radionecrosis after brain metastasis radiosurgery is predicted by a continuous function of the V12Gy","volume":"27","author":"Daisne","year":"2021","journal-title":"Clin Trans Radiat Oncol"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.1186\/1748-717x-6-48","article-title":"Stereotactic radiosurgery for brain metastases: analysis of outcome and risk of brain radionecrosis","volume":"6","author":"Minniti","year":"2011","journal-title":"Radiat Oncol"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.1016\/s0360-3016(01)01622-4","article-title":"Radiosurgery for patients with brain metastases: a multi-institutional analysis, stratified by the RTOG recursive partitioning analysis method","volume":"51","author":"Sanghavi","year":"2001","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2023.109920","article-title":"Factors associated with radiation necrosis and intracranial control in patients treated with immune checkpoint inhibitors and stereotactic radiotherapy","volume":"189","author":"Hall","year":"2023","journal-title":"Radiotherapy Oncol J Eur Soc For Ther Radiol Oncol"}],"container-title":["Frontiers in Oncology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2026.1894130\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T04:27:53Z","timestamp":1785731273000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2026.1894130\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,3]]},"references-count":31,"alternative-id":["10.3389\/fonc.2026.1894130"],"URL":"https:\/\/doi.org\/10.3389\/fonc.2026.1894130","relation":{},"ISSN":["2234-943X"],"issn-type":[{"value":"2234-943X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,3]]},"article-number":"1894130"}}