What dose/fractionation would you recommend for a large brainstem metastasis?

Topics: Radiation Oncology • Neuro-Oncology

What factors influence your choice of SRS vs more fractionated regimens?

Answer from: Radiation Oncologist at Academic Institution

This is always a difficult clinical decision; for "large" (however one chooses to define this) pontine/medullary/brainstem mets, most have moved away from single fraction SRS to 3 fraction SRS (27 Gy in 9 fractions), based largely on the results of the Italian trial. In this trial, 289 patients wit...

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Radiation Oncologist at Mercy Health Johnson Family Cancer Center
Is there a size where you would consider a more fr...

Answer from: Radiation Oncologist at Community Practice

The best dose may be 0 Gy for many patients with a large brainstem metastasis due to poor prognosis. Even among carefully selected patients in radiosurgery series median survival is only about 4-6 months (PMID:27478166; PMID:26555507), although there are a minority of patients that live beyond a yea...

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Radiation Oncologist at Mount Sinai Medical Center Miami
Sometimes the fact that it is large is because it ...

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