What is the best way to treat a small brainstem met with stereotactic radiosurgery?   

Small brain metastases in the brainstem can be treated with radiosurgery safely. Typically, the dose is dialed down to minimize the risk of radiation necrosis within the brainstem. At our institution, we typically reduce the dose down by one dose level using the RTOG scheme. For example, a 2 cm o...

Stereotactic radiosurgery (SRS) can be safely utilized in patients with brainstem metastases, and brainstem location should not be a sole exclusion criterion for SRS. We recently reported on the pooled the data from several institutions with experience in Gamma Knife radiosurgery internationally, an...

We also reduce the dose to the 16-18 Gy region using very tight margins to the contrast enhancing volume on the planning MRI. The difficulty with dosing in this region is finding the balance between maximising the chance of tumor control and minimising the risk of radiation necrosis -other factors s...

The quartz trial is going to be a big problem, poorly applied by non-radoncs and radoncs alike. That aside, there are two big issues that influence who should (or should not) treat brain stem metastases; the first is obvious: knowing how to apply scatter shot data. To simply say "follow guidelines" ...

I think these kind of situations are going to become more common now that the Quartz trial was just published Mulvenna P Lancet sept 2, 2016 (maybe someone can comment on it).I think it makes a lot of sense to hypfractionate with a small margin 5 Gy x 5 or 6 Gy x 5. There is a recent editorial from...

In Dr. Trifiletti's paper, the complication rate is 7.4 %, which seems to be consistent with other published Gamma Knife literature. There was only a 32% survival rate at 12 months. As such, actual complication rate for long term survivors could be higher. These lesions can prove to be very diff...

Our Recent publication : here is a preview Safety and Volumetric Analysis of Tumor Reduction in Gamma Knife Radiosurgery for Brainstem Metastases Evan K. Winograd MD1,3, Charlotte I. Rivers MD2, Robert A. Fenstermaker MD1,3, Andrew J. Fabiano MD1,3, Robert J. Plunkett MD1,3, Dheerendra Prasad MD M...