{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T05:02:33Z","timestamp":1790226153883,"version":"4.1.0"},"reference-count":16,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T00:00:00Z","timestamp":1790208000000},"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>Background<\/jats:title>\n                    <jats:p>Treatment options for disseminated intracranial recurrence after whole-brain radiotherapy (WBRT) are limited. Repeat WBRT offers modest efficacy and may worsen neurocognitive function. Modern single-isocenter techniques such as HyperArc may enable efficient stereotactic radiotherapy (SRT) of numerous brain metastases.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>A 62-year-old man with extensive-stage small-cell lung cancer and more than 40 brain metastases received systemic therapy followed by WBRT with 30 Gy in 10 fractions, resulting in near-complete intracranial regression. Approximately ten months later, magnetic resonance imaging revealed 41 new lesions and progression of 3 previously detected metastases. Because of his excellent performance status, all 44 lesions were treated with fractionated HyperArc SRT using 21.0 Gy in 3 fractions. Standardized neurocognitive testing was performed before SRT and repeated after 4 and 12 weeks. It demonstrated only selective deterioration without global or subjectively relevant impairment. Follow-up imaging after subsequent initiation of tarlatamab showed marked regression after 4 weeks and near-complete response after 3 months. Two additional lesions were subsequently treated with SRT, followed 7 months later by a second HyperArc course for 8 new metastases. At last follow-up, no treated lesion had locally recurred, and no radiographic radionecrosis was observed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Fractionated single-isocenter HyperArc SRT may represent a feasible salvage option for carefully selected patients with extensive intracranial recurrence after WBRT. The observed local control and limited neurocognitive deterioration support further prospective evaluation of this approach.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fonc.2026.1949603","type":"journal-article","created":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T04:35:52Z","timestamp":1790224552000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Case Report: Simultaneous stereotactic re-irradiation using HyperArc for 44 brain metastases after whole-brain radiotherapy"],"prefix":"10.3389","volume":"16","author":[{"given":"Maximilian","family":"R\u00f6mer","sequence":"first","affiliation":[{"name":"Department of Radiotherapy and Radiation Oncology, Jena University Hospital","place":["Jena, Germany"]},{"name":"Comprehensive Cancer Center Central Germany","place":["Jena, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Bublak","sequence":"additional","affiliation":[{"name":"Comprehensive Cancer Center Central Germany","place":["Jena, Germany"]},{"name":"Department of Neurology, Jena University Hospital","place":["Jena, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irina","family":"M\u00e4urer","sequence":"additional","affiliation":[{"name":"Comprehensive Cancer Center Central Germany","place":["Jena, Germany"]},{"name":"Department of Neurology, Jena University Hospital","place":["Jena, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philipp","family":"Franke","sequence":"additional","affiliation":[{"name":"Department of Radiotherapy and Radiation Oncology, Jena University Hospital","place":["Jena, Germany"]},{"name":"Comprehensive Cancer Center Central Germany","place":["Jena, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sonia","family":"Drozdz","sequence":"additional","affiliation":[{"name":"Department of Radiotherapy and Radiation Oncology, Jena University Hospital","place":["Jena, Germany"]},{"name":"Comprehensive Cancer Center Central Germany","place":["Jena, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georg","family":"Wurschi","sequence":"additional","affiliation":[{"name":"Department of Radiotherapy and Radiation Oncology, Jena University Hospital","place":["Jena, Germany"]},{"name":"Comprehensive Cancer Center Central Germany","place":["Jena, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noreen","family":"Murr","sequence":"additional","affiliation":[{"name":"Department of Radiotherapy and Radiation Oncology, Jena University Hospital","place":["Jena, Germany"]},{"name":"Comprehensive Cancer Center Central Germany","place":["Jena, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Klaus","family":"Pietschmann","sequence":"additional","affiliation":[{"name":"Department of Radiotherapy and Radiation Oncology, Jena University Hospital","place":["Jena, Germany"]},{"name":"Comprehensive Cancer Center Central Germany","place":["Jena, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthias","family":"M\u00e4urer","sequence":"additional","affiliation":[{"name":"Department of Radiotherapy and Radiation Oncology, Jena University Hospital","place":["Jena, Germany"]},{"name":"Comprehensive Cancer Center Central Germany","place":["Jena, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,24]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1093\/neuonc\/noab101","article-title":"Epidemiology of brain metastases and leptomeningeal disease","volume":"23","author":"Lamba","year":"2021","journal-title":"Neuro Oncol"},{"key":"B2","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":"B3","doi-asserted-by":"publisher","DOI":"10.1016\/0360-3016(94)00550-8","article-title":"Neuropsychological effects of cranial radiation: Current knowledge and future directions","volume":"31","author":"Roman","year":"1995","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(09)70263-3","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","year":"2009","journal-title":"Lancet Oncol"},{"key":"B5","doi-asserted-by":"publisher","first-page":"408","DOI":"10.1007\/s12032-025-02970-4","article-title":"Evaluation of the efficacy and safety of Hyperarc stereotactic radiotherapy for the treatment of lung cancer brain metastasis","volume":"42","author":"Zhu","year":"2025","journal-title":"Med Oncol"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2011.03.020","article-title":"Outcomes after whole brain reirradiation in patients with brain metastases","volume":"82","author":"Son","year":"2012","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"B7","doi-asserted-by":"publisher","first-page":"5293","DOI":"10.3390\/cancers14215293","article-title":"Re-whole brain radiotherapy may be one of the treatment choices for symptomatic brain metastases patients","volume":"14","author":"Ono","year":"2022","journal-title":"Cancers"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1016\/s0360-3016(98)90026-8","article-title":"Brain metastases: Results and effects of re-irradiation","volume":"15","author":"Hazuka","year":"1988","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1016\/j.canrad.2024.09.005","article-title":"Brain metastases reirradiation","volume":"28","author":"Petit","year":"2024","journal-title":"Cancer Radiother"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1097\/00006123-200004000-00017","article-title":"Radiosurgical salvage therapy for patients presenting with recurrence of metastatic disease to the brain","volume":"46","author":"Chen","year":"2000","journal-title":"Neurosurgery"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1016\/j.wneu.2018.11.238","article-title":"A second course of stereotactic image-guided robotic radiosurgery for patients with cerebral metastasis","volume":"123","author":"Jiang","year":"2019","journal-title":"World Neurosurg"},{"key":"B12","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":"B13","doi-asserted-by":"publisher","DOI":"10.1016\/j.adro.2019.08.013","article-title":"Single-isocenter multitarget stereotactic radiosurgery is safe and effective in the treatment of multiple brain metastases","volume":"5","author":"Palmer","year":"2020","journal-title":"Adv Radiat Oncol"},{"key":"B14","doi-asserted-by":"publisher","first-page":"1790","DOI":"10.3390\/cancers15061790","article-title":"Re-whole brain radiotherapy for brain metastases: How to evaluate an outcome of repeat treatment when its first use is debatable","volume":"15","author":"Kepka","year":"2023","journal-title":"Cancers"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1200\/jco-25-00056","article-title":"Stereotactic radiosurgery in patients with small cell lung cancer and 1-10 brain metastases: A multi-institutional, phase II, prospective clinical trial","volume":"43","author":"Aizer","year":"2025","journal-title":"J Clin Oncol"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1016\/j.adro.2024.101509","article-title":"Safety and feasibility of stereotactic radiosurgery for patients with 15 or more brain metastases","volume":"9","author":"Upadhyay","year":"2024","journal-title":"Adv Radiat Oncol"}],"container-title":["Frontiers in Oncology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2026.1949603\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T04:36:17Z","timestamp":1790224577000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2026.1949603\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,24]]},"references-count":16,"alternative-id":["10.3389\/fonc.2026.1949603"],"URL":"https:\/\/doi.org\/10.3389\/fonc.2026.1949603","relation":{},"ISSN":["2234-943X"],"issn-type":[{"value":"2234-943X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,24]]},"article-number":"1949603"}}