Stereotactic irradiation for brain lesions

Abstract

Stereotactic irradiation is the most suited for intracranial lesions. Brain STI is also advantageous for the integration of multiple imaging modalities. In this regard, STI for intracranial AVM played a pioneering role; the integration of angiography and CT was mandatory in the treatment planning. The integration of MRI in the brain STI made the accurate target delineation possible for the lesions located in posterior fossa (i.e., vestibular schwannoma) and skull base tumors (i.e., pituitary tumors). The spread of 3T-MRI, which is capable of visualize small brain metastases, and the advent of irradiation techniques promoted the STI for multiple brain metastases status. The integration of PET information that visualize the heterogeneous bio-activity within the tumor promoted the use of the simultaneous integrated boost (SIB) for gliomas. It is now becoming important how to lead to optimal personalization of indication. In the secondary analysis of JROSG99-1 indicated that the combination of WBRT and STI might lead to better overall survival due to better intracranial tumor control compared with SRS alone. This is an example of personalized medicine and this concept will be important for the optimal expansion of brain STI.