Stereotactic radiosurgery: at the threshold or at the crossroads?

Area of Science:

• Neurosurgery
• Radiation Oncology
• Medical Physics

Background:

• Stereotactic radiosurgery (SRS) has been utilized globally since 1951, with over 15,000 patients treated.
• Initially focused on arteriovenous malformations, SRS is increasingly adopted for benign and malignant brain tumors as an alternative to surgical resection.
• The application of SRS in functional neurosurgery is under ongoing investigation.

Purpose of the Study:

• To review the evolution, applications, and challenges of stereotactic radiosurgery.
• To highlight the importance of multidisciplinary collaboration and regulatory oversight in SRS.
• To identify critical areas for future research in SRS, including dose, histology, and volume variables.

Main Methods:

• Review of historical data and existing literature on stereotactic radiosurgery.
• Analysis of benefits and risks associated with various SRS delivery devices.
• Examination of current trends and challenges in the proliferation of SRS centers.

Main Results:

• Over 15,000 patients have undergone SRS, with over 6,000 treated for arteriovenous malformations.
• SRS is increasingly used for brain tumors, presenting an alternative to microsurgery.
• Concerns exist regarding patient selection, quality assurance, and training in rapidly expanding SRS centers.

Conclusions:

• Stereotactic radiosurgery is a rapidly advancing multidisciplinary field requiring collaboration among neurosurgeons, radiation oncologists, radiologists, and physicists.
• Addressing critical clinical and radiobiological questions through further research is essential.
• Continued dialogue and adherence to standards are necessary for the responsible progression of SRS applications.