Stereotactic Radiosurgery for Brain Metastases

  • Christophe Marques
  • Eric L. ChangEmail author


Stereotactic radiosurgery (SRS) refers to the use of a three-dimensional coordinate system (“stereotactic”) to deliver high doses of image-guided focal radiation to intracranial targets with submillimeter localization in a noninvasive manner (“radiosurgery”) as a substitute for surgery while avoiding irradiation of the surrounding healthy tissue. Dr. Lars Leksell, a prominent neurosurgeon in Sweden, pioneered SRS in the 1950s using orthovoltage X-ray tube radiation to treat trigeminal neuralgia-related facial pain [1]. Gamma knife radiosurgery (GKRS), which uses cobalt-60 as the source of ionizing radiation, was developed by Dr. Leksell and physicists Dr. Kurt Lidén and Dr. Börje Larsson in 1967 as a surgical tool to produce discoid-shaped radiation lesions for functional neurosurgery patients with movement disorders and intractable pain refractory to conventional treatment (Fig. 17.1). Since the 1970s, SRS was used for vascular malformations unsuitable for resection or embolization as well as for benign tumors.



Three-dimensional conformal radiotherapy


American Society for Radiation Oncology


Brain metastasis/metastases


Cone-beam computed tomography


Conformity (or conformality) index


CyberKnife radiosurgery


Computed tomography


Clinical target volume


External beam radiation therapy


Eastern Cooperative Oncology Group


European Organization for Research and Treatment of Cancer


 Functional Assessment of Cancer Therapy-Brain


Fractionated SRS


Gradient index


Gamma knife radiosurgery


Gross tumor volume


Hyperbaric oxygen


Hazard ratio


Hopkins Verbal Learning Test-Revised


Isodose line




Karnofsky performance status




Linear accelerator


Multileaf collimator


Mini–Mental State Examination


Magnetic resonance imaging


Monitor unit




National Cancer Institute Common Terminology Criteria for Adverse Events


Non-small cell lung cancer


Prescription isodose volume


Performance status


Planning target volume




Quality of life


Renal cell carcinoma


Radiation-induced optic neuropathy


Radionecrosis or radiation necrosis


Recursive partitioning analysis




Randomized controlled trial


Radiation Therapy Oncology Group


Small cell lung cancer


Surface guided radiation therapy


Selectivity index


Stereotactic radiosurgery


Target volume


Vitamin E


Volumetric modulated arc therapy


Whole brain radiation therapy


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© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Department of Radiation OncologyKeck School of Medicine of USCLos AngelesUSA

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