Stereotactic Radiosurgery of Multiple Brain Metastases: A Review of Treatment Techniques

Abstract

The advancement of systemic targeted treatments has led to improvements in the management of metastatic disease, particularly in terms of survival outcomes. However, brain metastases remain less responsive to systemic therapies, underscoring the significance of local interventions for comprehensive disease control. Over the past years, the threshold for treating brain metastases through stereotactic radiosurgery has risen. Yet, as the number of treated metastases increases, treatment complexity and duration also escalate. This trend has made multi-isocenter radiosurgery treatments, such as those with the Gamma Knife, challenging to plan and lengthy for patients. In contrast, single-isocenter approaches employing linear accelerators offer an efficient and expeditious treatment option. This review delves into the literature, comparing different linear-accelerator-based techniques with each other and in relation to dedicated systems, focusing on dosimetric considerations and feasibility.

Keywords: brain metastases; dynamic conformal arc therapy (DCAT); single isocenter; stereotactic radiosurgery; volumetric arc therapy (VMAT).

Figure 1

A relative comparison between the different treatment techniques; GK—Gamma Knife; SI-DCAT—single-isocenter dynamic arc therapy; SI-VMAT—single-isocenter volumetric arc therapy.