Frameless stereotactic radiosurgery in the management of brain metastases: long-term oncologic and toxicity…

Cohort studyJournal of neuro-oncology· Jul 2026

Frameless stereotactic radiosurgery in the management of brain metastases: long-term oncologic and toxicity outcomes.

Swati Kinger, Geoffrey Sedor, Elizabeth J Buss … Matthew Gallitto

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Neurosurgical OncologyCohort studyTreatmentQ2IF 3.2

Frameless Gamma Knife radiosurgery achieved excellent local control of brain metastases at 1 year.

Frameless stereotactic radiosurgery in the management of brain metastases: long-term oncologic and toxicity outcomes.

Swati Kinger … Matthew Gallitto

Journal of neuro-oncology · Jul 2026 · Q2 in Neurology

Background

Gamma Knife radiosurgery (Gamma Knife radiosurgery) is a widely accepted treatment modality for brain metastases and has historically relied on pin-based frame fixation, with a frameless option introduced in recent years.

Purpose

In this study, we sought to evaluate outcomes of single-fraction frameless Gamma Knife radiosurgery for patients treated at our institution between 2018 and 2024.

Methods

We retrospectively reviewed the medical records of patients treated with single-fraction frameless Gamma Knife radiosurgery for brain metastases.

n = 140 patients

Results

local tumor control held in nearly all patients at one year

1-year local control

98%

2-year local control

97%

More results

Primary tumor types included non-small cell lung (32%), breast (21%), melanoma (16%), and gastrointestinal (9%).

Median marginal dose was 20 Gy, with mean target volume of 0.14 cc (0.04-0.56).

Median clinical follow-up time was 2.4 years.

Median overall survival was 2.5 years (95% CI, 1.992-4.271).

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Conclusion · 1 of 2

In this single-institutional experience, frameless Gamma Knife radiosurgery demonstrated excellent oncologic outcomes, adding to the growing body of literature that frameless-based radiosurgical techniques do not compromise locoregional control.

Conclusion · 2 of 2

To our knowledge, this is the largest single-institution frameless Gamma Knife radiosurgery cohort reported to date.

Frameless stereotactic radiosurgery in the management of brain metastases: long-term oncologic and toxicity outcomes.

Frameless stereotactic radiosurgery in the management of brain metastases: long-term oncologic and toxicity outcomes.

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