How do you approach SRS for a brain metastasis in an eloquent area of the brain?

Topics: Radiation Oncology • Neuro-Oncology • Stereotactic Radiosurgery

Do you decrease total dose, increase the number of fractions, or both? What factors, in addition to size and location, do you consider?

Answer from: Radiation Oncologist at Academic Institution

Short of metastases in the brainstem or next to the optic nerve/chiasm, we do not routinely decrease the dose or hypofractionate SRS in other eloquent areas such as the motor strip. While radiation necrosis is the main concern, the risk of recurrence which is shown to be higher with diminished doses...

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Radiation Oncologist at Mallory Radiotherapy, PLLC
In the exception you mentioned, how do you dose fr...

Answer from: Radiation Oncologist at Academic Institution

I agree with @Samuel T. Chao. For bigger lesions in eloquent areas, I will try to generate a plan with steeper dose gradient. This can be accomplished by using a peripheral shot technique which we started using when I was at OSU. Dr. Jian Wang from OSU came up with this concept and it works.

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Radiation Oncologist at Lake Huron Medical Center
Is there a reference for the peripheral shot techn...

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