Confronting ethical challenges and guideline deviations in neuro-oncological radiosurgery

Stereotactic radiosurgery (SRS) has transformed neurooncological care through its precision, minimally invasive nature. SRS involves multiple, convergent beams of high energy gamma rays, X-rays, or protons at a precisely defined treatment area. As the use of SRS continues to grow in neuro-oncology, it has brought with it a range of ethical and clinical concerns. This narrative review examines how deviations from accepted clinical guidelines and inappropriate use of SRS-such as overuse in low-volume centers, financial motivations, poor compliance with protocols, and unsuitable patient selection-can lead to compromised patient care. These practices not only pose risks to patient safety and outcomes but also threaten to undermine trust in the medical system. By reviewing real-world examples, this review highlights the necessity of stronger multidisciplinary decision-making, improved oversight and training of the clinical teams involved in delivering SRS. Addressing these issues is essential to ensure that radiosurgery remains a safe, effective, and ethically sound treatment option in the neuro-oncology practice.