title: Stereotactic radiosurgery (SRS) for brain metastases: a systematic review.
abstract: In many patients with brain metastases, the primary therapeutic aim is symptom palliation and maintenance of neurologic function, but in a subgroup, long-term survival is possible. Local control in the brain, and absent or controlled extracranial sites of disease are prerequisites for favorable survival. Stereotactic radiosurgery (SRS) is a focal, highly precise treatment option with a long track record. Its clinical development and implementation by several pioneering institutions eventually rendered possible cooperative group randomized trials. A systematic review of those studies and other landmark studies was undertaken. Most clinicians are aware of the potential benefits of SRS such as a short treatment time, a high probability of treated-lesion control and, when adhering to typical dose/volume recommendations, a low normal tissue complication probability. However, SRS as sole first-line treatment carries a risk of failure in non-treated brain regions, which has resulted in controversy around when to add whole-brain radiotherapy (WBRT). SRS might also be prescribed as salvage treatment in patients relapsing despite previous SRS and/or WBRT. An optimal balance between intracranial control and side effects requires continued research efforts.
authors.affiliation: Department of Oncology and Palliative Medicine, Nordland Hospital, 8092 Bodø, Norway. carsten.nieder@nlsh.no.
authors.forename: Carsten
authors.initials: C
authors.lastname: Nieder
authors.forename: Anca L
authors.initials: AL
authors.lastname: Grosu
authors.forename: Laurie E
authors.initials: LE
authors.lastname: Gaspar
mesh_terms: D001932:Brain Neoplasms / Q000556:secondary* / Q000601:surgery*; D006801:Humans; D016634:Radiosurgery