What is your cutoff for the maximum number and size of brain metastases that you will treat with SRS?

Sadly, the level 1 evidence needed to truly delineate the greatest benefits from SRS will probably never be realized beyound what we already know: SRS shows an OS benefit to pateint with 1 intracranial met and a CNS-DFS benefit to 2-3 mets. Beyond that, it's better in terms of preservation of neuroc...

Everything that can be counted does not necessarily count; everything that counts cannot necessarily be counted. - Albert Einstein

We dont count the mets as long as patient has a high KPS and has systemic options.

1. Rivers C, Tranquilli M, Prasad S, Winograd E, Plunkett R, J, Fenstermaker R, A, Fabia...

It depends on whether the patient has newly diagnosed brain metastases or whether he/she has already had whole brain radiation therapy (WBRT).

If prior WBRT then I will treat growing lesions up to 10 but since I am treating usually on the brainlab machine with relocatable mask, I usually divide into...

As in much of retrospective observational studies, we never know the process of selection. SRS is incredibly benign. As we will now see nationally with President Carter, if I had what he had I'd want SRS, not WBRT. The indictment of WBRT is anecdotal. How do you rule out underlying micrometastasis? ...

http://www.ncbi.nlm.nih.gov/pubmed/21121790

I think most radio surgeons would say about 10 metastases would be maximum especially if new presentation with no WBRT. Some people would use total metastases volume constraints (20cc in most european studies, 15mm in the Yamamoto data)

http://www.ncbi.nlm.n...