Vol 27, No 1 (2022)
Review paper
Published online: 2021-12-10

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Stereotactic radiotherapy for brain oligometastases

Marco Lupattelli1, Paolo Tini2, Valerio Nardone3, Cynthia Aristei1, Simona Borghesi4, Ernesto Maranzano5, Paola Anselmo5, Gianluca Ingrosso1, Letizia Deantonio6, Michela Buglione di Monale e Bastia7
Rep Pract Oncol Radiother 2022;27(1):15-22.

Abstract

Brain metastases, the most common metastases in adults, will develop in up to 40% of cancer patients, accounting for more than one-half of all intracranial tumors. They are most associated with breast and lung cancer, melanoma and, less frequently, colorectal and kidney carcinoma. 

MRI is the gold standard for diagnosis. For the treatment plan, CT images are co-registered and fused with a gadolinium-enhanced T1-weighted MRI where tumor volume and organs at risk are contoured. Alternatively, plain and contrast-enhanced CT scans are co-registered. Single-fraction stereotactic radiotherapy (SRT) is used to treat patients with good performance status and up to 4 lesions with a diameter of 30 mm or less that are distant from crucial brain function areas. Fractionated SRT (2–5 fractions) is used for larger lesions, in eloquent areas or in proximity to crucial or surgically inaccessible areas and to reduce treatment-related neurotoxicity. The single-fraction SRT dose, which depends on tumor diameter, impacts local control. Fractionated SRT may encompass different schedules. No randomized trial data compared the safety and efficacy of single and multiple fractions. Both single-fraction and fractionated SRT provide satisfactory local control rates, tolerance, a low risk of transient acute adverse events and of radiation necrosis the incidence of which correlated with the irradiated brain volume. 

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