What dose/fractionation would you recommend for a large brainstem metastasis?
What factors influence your choice of SRS vs more fractionated regimens?
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For brainstem metastases, which SRS schedule do you use?
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2 Answers
Mednet MemberInvited Expert
Radiation Oncology · Florida International University
Answered on
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 with...
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Mednet Member
Radiation Oncology · The Oregon Clinic-Radiation Oncology West
Answered on
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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