Preoperative single-fraction SRS (≈16Gy) for resectable brain mets delivers ~82% 1-year local control with ~5% LMD in meta-analysis

Single-fraction preoperative stereotactic radiosurgery (SRS)—a high-dose, highly conformal radiation treatment delivered to an intact resectable brain metastasis immediately before planned surgery—was evaluated in a systematic review/meta-analysis of 10 studies (2016–2025) covering 617 patients. Pooled outcomes were 1-year local control 81.9% (95% CI 76.9–85.9; I²=43%), 1-year leptomeningeal disease (LMD) 4.6% (95% CI 2.8–7.4; I²=0%), and 1-year overall survival 60.2% (95% CI 55.5–64.8; I²=0%) at a median prescribed dose of 15.8Gy (range 14.5–17.0). Versus the common postoperative cavity SRS paradigm, these results look broadly comparable for 1-year local control (often ~70–90%) but potentially lower for LMD (often reported ~10–20% at 1 year in postoperative cavity series/trials), supporting ongoing randomized testing (NCT05341739, NCT03741673).