How do you approach treatment of brain metastases of varying sizes with SRS?

If fractionating one metastasis over 3 or 5 fractions, would you also treat a small metastasis with the same number of fractions or would you give single fraction treatment? What is your rationale?

Answer from: Radiation Oncologist at Community Practice

The UAB institutional paradigm has evolved to the following current practice patterns.Most patient's treatment plans are generated and delivered via HyperArc. Nearly all patients are treated on a Varian Edge with initial kv-kv, followed by CBCT/sim 6DOF alignment based on bony windowing with the VOI...

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Radiation Oncologist at Renaissance Institute of Precision Oncology & Radiosurgery
Add PTV according to your positional and imaging u...

Answer from: Radiation Oncologist at Academic Institution

So I think the question here is - would it be reasonable to consider treating a small brain metastasis that one would normally treat with single fraction SRS to fractionated SRS because there is plan to fractionate SRS a large brain metastasis? I don't think there's a wrong answer here. In general...

Answer from: Radiation Oncologist at Community Practice

No data to support this but I find that if I'm treating radio-resistant histology i.e., melanoma or RCC resection cavity and de novo mets, I like to give higher dose to de novo mets 22Gy in 1fx if small and fractionate large cavity 30Gy in 5 fractions if no gross tumor left behind. I agree, makes th...

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How do you approach treatment of brain metastases of varying sizes with SRS?

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