Stereotactic Radiosurgery Techniques and Quality Assurance for Brain Metastases

Brain metastases (BMs), a significant source of cancer-related morbidity and mortality, are the most frequent intracranial tumors emerging in up to 40% of all adult cancers during the disease course. Stereotactic radiosurgery (SRS) or fractionated stereotactic radiotherapy (FSRT) assuredly gained global acceptance by the radiation oncologists for the triumphant management of BMs, recognizing the dismal prognosis of such patients with other therapies, including the whole-brain radiotherapy (WBRT). Other skepticisms on the cognitive deterioration and comparably lower tumor control rates offered by the conventional WBRT further incited the rapid adoption of the SRS/FSRT to the routine radiation oncology practice. Nevertheless, the remarkable variations among the treatment algorithms and the treatment planning systems of the gamma knife-, linear accelerator- (LINAC), tomotherapy-, robotic Cyberknife-, or the proton therapy-based SRS render the administration of SRS/FSRT severely stressful. On that account, the present chapter intended to offer an intensive layout of the requisite standards of the SRS/FSRT procedures from the initial patient fixation to the final quality assurance steps of guaranteeing the machine quality and accurate delivery of the prescribed dose.