Fractionated stereotactic radiotherapy: rationale and methods

Stereotactic radiosurgery (SRS) has become a widely accepted technique for the treatment intracranial neoplasms. Combined with modern imaging modalities, SRS has established its efficacy in a variety of indications. From the outset, however, it was recognized that the delivery of a single large dose of radiation was essentially "bad biology made better by good physics." To achieve the accuracy required to compensate for this biological shortcoming, the application of SRS has required that a neurosurgical head frame of some sort be rigidly attached to the patients head. Historically, this prerequisite has, primarily for practical reasons, precluded the delivery of multiple fractions over multiple days. With recent improvements in immobilization and repeat fixation, the good biology of fractionated delivery has been realized. This technique, which has come to be known as stereotactic radiotherapy (SRT), has significantly expanded the efficacy of the technique through the use of accurate physical targeting coupled with the basic radiobiological principles gleaned from decades of clinical experience.