Stereotactic Radiosurgery   

This has become standard practice at our institution for patients with a good performance status, with whole brain radiotherapy given after the comple...

Does fractionation (or location) influence this decision? What is your preferred steroid dose?

In patients with contraindications to receiving an MRI scan, are other imaging modalities sufficient to treat patients with SRS?

Should it include the entire brain (normal brain + target) or just the normal brain (brain - target)?  How does the V10 or V12 constraint change ...

What maximum dose do you allow to “connect” adjacent metastatic lesions receiving SRS/SRT? What is this value for one-, three-, and five-...

Is there evidence that supports/refutes the safety of concurrent use?

If progression is proven by imaging modality (MRI spectroscopy, perfusion and PET/CT), is there evidence for retreatment with a second course of SRS?&...

Would this be any different for whole brain radiotherapy?

There are solid data from Emory, Korea and others suggesting that is as effective as single fraction SRS but has less complications. 

To what degree, if any, is a neurosurgeon involved in the planning of SRS for brain metastases?

The 2014 "Choosing Wisely" list, released this past September, includes the assertion that we should not "routinely add adjuvant whole brain radiation...

For example, in a patient minimal brain and liver metastasis, would you treat all sites definitively?

Any advice on how to safely incorporate it into our practice?

How do the number of lesions treated and histology affect your decision making?

Is heparin or warfarin routinely held prior to treatment?  

In RTOG 9508, 4 cm was the cut-off size for WBRT followed by SRS. 

It is my impression that for brain metastases >3 cm it may be preferable to deliver fractionated SRT versus the RTOG dose of 15 Gy SRS, if WBRT is ...