Modern Radiosurgery Approaches for Brain Metastases

Brain metastases affect up to 30% of cancer patients and can cause significant neurological effects. Treatment of brain metastases requires a multidisciplinary approach with surgery, radiation modalities, and systemic therapy all playing a specialized role in its management. Stereotactic radiosurgery (SRS) is a specialized type of highly conformal radiation therapy, allowing for high doses to be focally delivered to the tumor, while causing a sharp dose falloff to the surrounding normal tissues. SRS is utilized for both intact brain metastases and postoperative surgical resection cavities. SRS has shown good local control, similar survival outcomes to whole brain radiation therapy (WBRT), and superior preservation of neurocognition compared with WBRT. Ongoing prospective studies are investigating the use of SRS in the setting of patients with 5 or more brain metastases, preoperative SRS, and the timing of administration of SRS with respect to systemic therapy.