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Methods| The institutional review board of Dana-Farber Cancer Institute approved the project and informed consent was waived. We identified 480 patients with newly diagnosed brain metastases secondary to NSCLC (n= 294), melanoma (n= 145), and RCC (n= 41) treated with stereotactic radiation at Brigham and Women’s Hospital/Dana-Farber Cancer Institute between 2001 and 2015; of these, 115 patients received immunotherapeutic checkpoint inhibitors (ipilimumab, pembrolizumab, or nivolumab) whereas 365 did not. Target tumors that were 0 to 2 cm, 2 to 3 cm, and larger than 3 cm in maximal diameter generally received 18 to 20 Gy in 1 fraction, 18 Gy in 1 fraction, and 25 to 30 Gy in 5 fractions, respectively. Patients received immunotherapy for a median of 14.3 (IQR, 8.0-31.0) weeks. Symptomatic radiation necrosis was defined as an enlarging lesion after stereotactic radiation causing neurologic …