A multi-institutional survey on radiosurgery for multiple brain metastases in Latin America

Disparity in the delivery of stereotactic radiosurgery (SRS) treatment for multiple intracranial lesions has been observed in six countries in Latin America. Moreover, no consensus exists on tumor margins for these treatments. This work aims to collect multi-institutional data on the SRS technique for multiple brain lesions, based on clinical practice across various centers. A Google Forms survey was developed to analyze and report the data. The anonymous survey was distributed to specialists, including neurosurgeons, radiation oncologists, medical physicists, and dosimetrists via professional societies in Latin America. A total of 23 from six Latin American countries participated. Among them, 52.1% treat 1 to 25 cases of SRS of brain metastases annually, and 69.5% operate with a single treatment machine. The most commonly used imaging system was cone beam computed tomography (78.2%), followed by ExacTrac™ (34.7%). However, responses regarding machine uncertainties and margin assignment revealed significant variability. Multi-institutional disparities in Latin America exist in technical and clinical aspects of SRS for multiple brain lesions, largely due to differences in technology availability and a lack of comprehensive understanding of the sources of uncertainty.