Radiosurgery Techniques for Brain Metastases
Erkan Topkan *
Department of Radiation Oncology, Medical Faculty, Baskent University, Adana, Turkey.
Ahmet Kucuk
Mersin City Education and Research Hospital, Radiation Oncology Clinics, Mersin, Turkey.
Sukran Senyurek
Department of Radiation Oncology, Koc University, School of Medicine, Istanbul, Turkey.
Duygu Sezen
Department of Radiation Oncology, Koc University, School of Medicine, Istanbul, Turkey.
Nulifer Kılıc Durankus
Department of Radiation Oncology, Koc University, School of Medicine, Istanbul, Turkey.
Eyub Yasar Akdemir
Department of Radiation Oncology, Koc University, School of Medicine, Istanbul, Turkey.
Yucel Saglam
Department of Radiation Oncology, Koc University, School of Medicine, Istanbul, Turkey.
Yasemin Bolukbasi
Department of Radiation Oncology, Koc University, School of Medicine, Istanbul, Turkey.
Berrin Pehlivan
Department of Radiation Oncology, Bahcesehir University, Istanbul, Turkey.
Ugur Selek
Department of Radiation Oncology, Koc University, School of Medicine, Istanbul, Turkey.
*Author to whom correspondence should be addressed.
Abstract
As a notable cause of cancer-related morbidity and mortality, brain metastases (BMs) represent the most prevalent intracranial tumors arising in up to 40% of all adult solid tumors during the course of treatment. Intracranial stereotactic radiosurgery (SRS) or fractionated stereotactic radiotherapy (FSRT) gained wide appreciation by the radiation oncology communities for the treatment of BM with regards to the grim prognosis of such patients after alternative therapies, including the whole brain radiotherapy (WBRT). Additional concerns on the neurocognitive deterioration and comparably low tumor control rates offered by the conventional WBRT further quickened the implementation of SRS to the daily practice of radiation oncology clinics. However, the striking diversities among the treatment algorithms and the treatment planning systems of the gamma knife-, linear accelerator- (LINAC), tomotherapy-, robotic Cyberknife-, or the proton therapy-based SRS render the administration of SRS/FSRT challenging. Acknowledging these difficulties, the present review intended to offer a thorough outline of the main principals of the SRS/FSRT technique from the initial patient fixation to the final machine and dose delivery quality assurance treads.
Keywords: Radiosurgery, fractionated stereotactic radiotherapy, treatment planning, treatment delivery, quality assurance.