a report by David Roberge, MD

Assistant Professor, Radiation Oncology, McGill University

It was decades after the introduction of the first concept of stereotactic radiosurgery (SRS) at the Karolinska Institute¹ that stereotactic irradiation began to see widespread use in the treatment of brain tumors. Despite many technical changes since the 1950s, radiosurgery remains a radiotherapy technique characterized by accurate delivery of high doses of radiation in a single session to small, stereotactically defined targets with sharp dose fall-off outside the targeted volume. Such a treatment appears ideally suited to parenchymal brain metastases—tumors geographically well delimited with minimal infiltration into the adjacent brain.² Unfortunately, such metastases are a common occurrence, representing approximately 250,000 cases per year in the US alone.³ Thus, even if only a fraction of these patients are referred for SRS, the management of brain metastases invariably represents a significant fraction of the workload of a radiosurgery practice. Until recently most reports supporting the use of SRS were retrospective case series. This has changed with the publication of randomized trials characterizing the benefits of SRS in the management of newly diagnosed brain oligometastases. [Read more…]