[Radiosurgery of brain metastasis: reflexions, controversies and unanswered questions in 2004]

The quantity of results published since the development of the radiochirurgie does not always lead to consider overall the consequences of the introduction of this treatment into the therapeutic arsenal of the clinician. The role of this treatment in front of the surgery, its association with the whole brain radiation therapy, the impact on the survival of this treatment and the incorporation of the various prognostic factors to the therapeutic decision are some one of the unresolved question. Best indications of radiosurgery concern probably patient with a good performance status, without extra-cranial disease and presenting no more than 4 metastasis. However, in an obviously palliative context, any dogmatism must be avoided. Development of prospective trials is the best solution to well specify the indication of the technique.