Precision Radiation for Brain Metastases With a Focus on Hypofractionated Stereotactic Radiosurgery

Area of Science:

• Radiation Oncology
• Neurosurgery
• Medical Physics

Background:

• Single-fraction stereotactic radiosurgery (SF-SRS) is a standard treatment for 1-4 brain metastases, known for preserving neurocognition compared to whole brain radiotherapy.
• The evolution of radiation technology has enabled hypofractionated stereotactic radiosurgery (HF-SRS) as a viable alternative to SF-SRS.

Purpose of the Study:

• To review the outcomes of hypofractionated stereotactic radiosurgery (HF-SRS) for brain metastases.
• To discuss recent advancements including staged SRS, preoperative SRS, and hippocampal avoidance with simultaneous integrated boost radiotherapy.

Main Methods:

• This narrative review synthesizes existing literature on HF-SRS and related advanced techniques.
• Focuses on outcomes, technological advancements, and clinical applications.

Main Results:

• HF-SRS allows for the delivery of 25-35 Gy in 3-5 fractions, leveraging advanced image guidance and delivery systems.
• HF-SRS aims to reduce radiation necrosis and enhance local control, particularly for larger brain metastases.
• Emerging techniques like staged SRS, preoperative SRS, and hippocampal avoidance radiotherapy are also explored.

Conclusions:

• Hypofractionated SRS (HF-SRS) represents a significant advancement in the management of brain metastases, offering potential benefits over traditional SF-SRS.
• Technological progress in radiation delivery supports the safe and effective implementation of HF-SRS and other novel fractionation strategies.
• Further research into these advanced techniques will refine treatment paradigms for brain metastases.