Stereotactic radiosurgery for patients with brain metastases: current principles, expanding indications and opportunities for multidisciplinary care
Recommended Citation
Mansouri A, Ozair A, Bhanja D, Wilding H, Mashiach E, Haque W, Mikolajewicz N, de Macedo Filho L, Mahase SS, Machtay M, Metellus P, Dhermain F, Sheehan J, Kondziolka D, Lunsford LD, Niranjan A, Minniti G, Li J, Kalkanis SN, Wen PY, Kotecha R, McDermott MW, Bettegowda C, Woodworth GF, Brown PD, Sahgal A, and Ahluwalia MS. Stereotactic radiosurgery for patients with brain metastases: current principles, expanding indications and opportunities for multidisciplinary care. Nat Rev Clin Oncol 2025; 22(5):327-347.
Document Type
Article
Publication Date
5-1-2025
Publication Title
Nat Rev Clin Oncol
Abstract
The management of brain metastases is challenging and should ideally be coordinated through a multidisciplinary approach. Stereotactic radiosurgery (SRS) has been the cornerstone of management for most patients with oligometastatic central nervous system involvement (one to four brain metastases), and several technological and therapeutic advances over the past decade have broadened the indications for SRS to include polymetastatic central nervous system involvement (>4 brain metastases), preoperative application and fractionated SRS, as well as combinatorial approaches with targeted therapy and immune-checkpoint inhibitors. For example, improved imaging and frameless head-immobilization technologies have facilitated fractionated SRS for large brain metastases or postsurgical cavities, or lesions in proximity to organs at risk. However, these opportunities come with new challenges and questions, including the implications of tumour histology as well as the role and sequencing of concurrent systemic treatments. In this Review, we discuss these advances and associated challenges in the context of ongoing clinical trials, with insights from a global group of experts, including recommendations for current clinical practice and future investigations. The updates provided herein are meaningful for all practitioners in clinical oncology.
Medical Subject Headings
Humans; Radiosurgery; Brain Neoplasms; Combined Modality Therapy
PubMed ID
40108412
ePublication
ePub ahead of print
Volume
22
Issue
5
First Page
327
Last Page
347
