In what situations should stereotactic radiosurgery for brain cancer be considered as a treatment option?

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MineshMehtaMD (Physician - Oncology - Radiation (Verified) ) - 07 / 02 / 2012

Stereotactic radiosurgery has a well-established place in the management of certain conditions, for example patients with single brain metastases where survival can be prolonged, for patients with arteriovenousmalformations which can be obliterated, for trigeminal neuralgia, which can be controlled, for cluster headaches, etc. Increasingly, radiosurgery is being used in several patients with benign tumors such as schwannomas (especially vestibular, but also others), meningiomas, secreting pituitary adenomas, etc. Its role in low gradegliomas is ill-defined. In patients with high grade gliomas, no categorical survival difference has been identified with the use of radiosurgery, but this area remains under investigation; in contrast, for recurrent GBM, at least in well-selected patients, there maybe a role for this treatment.

However, the biggest growth area for radiosurgery is brain metastases. For patients with up to 4 brain metastases, the addition of radiosurgery to whole brain radiotherapy clearly improves local control. Increasingly, many patients with several brain metastases are being treated with radiosurgery alone, without whole brain radiotherapy, but it is important to remember that this also remains the subject of controversy and clinical trials.
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