Outcomes following stereotactic radiosurgery for small to medium-sized brain metastases are exceptionally dependent upon tumor size and prescribed dose

Abstract

The true incidence of brain metastases (BM) in cancer patients is unknown, but likely exceeds 20-40% depending upon the disease histology. 1 Modern treatments for BM focus on reducing treatment-related adverse effects, maintaining neurocognition, and obtaining durable local control. Historically, whole-brain radiotherapy (WBRT) was

Tuning-Target-Guided Inverse Planning of Brain Tumors With Abutting Organs at Risk During Gamma Knife Stereotactic Radiosurgery

“…For the entire cohort, one-year LC was 89% for the tumors with V32Gy > 24% of the total volume, vs LC of 67% for the tumors receiving V32Gy < 24% of the total volume. Similar findings were reported in other literatures [12,13]. A very conformal and high target dose was desired to improve LC and achieve therapeutic goals.…”

Brain Metastases: A Modern Multidisciplinary Approach

“…However, for smaller lesions, while higher doses can be safely used, it is not clear that they are necessary. A recent retrospective study from our group did not show a difference in local failure and radionecrosis in lesions ≤ 1 cm diameter treated with a dose of 15 Gy or 21 Gy 29 . In lesions greater than 1cm but less than 2 cm diameter, the incidence of local failures was significantly higher in those treated with a dose of 15 Gy.…”

Stereotactic Radiosurgery for Postoperative Metastatic Surgical Cavities: A Critical Review and International Stereotactic Radiosurgery Society (ISRS) Practice Guidelines

“…This is particularly important in the context of data which suggests that minimum doses >15 Gy in a single fraction are associated with superior local control than more conservative doses. 24 Indeed, 40% of patients had surgical cavities measuring >3 cm. The biologically equivalent doses of 12-14 Gy in a single fraction are lower than those prescribed in the WBRT arm, thereby negating the potential dose escalation benefit of SRS in terms of local control.…”