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Do you recommend homogenous or inhomogenous dose distribution for postoperative SRS/FSRT for a resected brain metastasis?
There are data for improved outcomes for inhomogeneous dose distribution in patients with intact brain tumors (Lucia et al, Radiother Oncol 2018), but I am unaware of data for postoperative patients. Does it matter if there is residual disease on post-operative imaging?
Answer from: Radiation Oncologist at Academic Institution
For most intracranial and all malignant targets, homogeneous planning leads to poorer dosimetry and bad radiosurgery. Just don't do it.
If you value conformity and gradient as plan quality metrics, you should not penalize heterogeneity within your target. For inversely planned SRS, the act of merel...
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