# N107C/CEC.3: postoperative radiosurgery versus whole-brain radiotherapy after resection of a brain metastasis

Source: https://onco.cc/key-papers/paper-n107c-brown-lancet-oncol-2017/  
OnCo record `paper-n107c-brown-lancet-oncol-2017` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

After surgery to remove a brain metastasis, focused radiosurgery to the cavity preserved thinking and memory far better than whole-brain radiotherapy and gave the same survival, so it became the standard.

## Summary

Phase 3 trial of 194 patients with one resected brain metastasis (and up to three unresected) randomised to stereotactic radiosurgery to the surgical cavity or whole-brain radiotherapy.

Cognitive deterioration-free survival was 3.7 versus 3.0 months (hazard ratio 0.47) and cognitive decline at six months was 52 versus 85 percent; overall survival was similar (12.2 versus 11.6 months) although whole-brain radiotherapy gave better intracranial control.

## Fields

- Kind: Key paper
- Last checked: 2026-09-17
- Journal: The Lancet Oncology
- Year: 2017
- DOI: 10.1016/S1470-2045(17)30441-2
- Authors: Brown PD, Ballman KV, Cerhan JH, et al.
- Findings: Cognitive deterioration at six months 52 percent vs 85 percent.; Median overall survival 12.2 vs 11.6 months (no difference).
- What it means: Surgical cavity radiosurgery, rather than whole-brain radiotherapy, follows resection of a brain metastasis in fit patients, part of the broader move away from whole-brain treatment.
- Caveats: Surgical bed control was lower with radiosurgery than with whole-brain radiotherapy (about 61 vs 81 percent at one year).; Leptomeningeal relapse is a concern after cavity radiosurgery.

## Sources

- Lancet Oncol 2017: https://doi.org/10.1016/S1470-2045(17)30441-2
- PubMed: https://pubmed.ncbi.nlm.nih.gov/28687377/

## Connected records

- cancers: [Brain metastases (secondary brain tumours)](https://onco.cc/cancers/secondary-brain-tumours/)
- journals: [The Lancet Oncology](https://onco.cc/journals/lancet-oncology/)

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