ABSTRACT
This chapter presents the current data and indications for postoperative image-guided single-fraction or hypofractionated stereotactic radiotherapy for resected brain metastases. Postoperative radiotherapy delivered to the resection cavity of a metastatic brain lesion is well tolerated with very little toxicity. The indications for post-operative cavity stereotactic radiosurgery (SRS) are derived from the recently published, multi-institutional, Alliance cooperative group phase III trial that compared cavity SRS to Whole-brain radiotherapy (WBRT) for resected brain metastases. WBRT is associated with increased adverse effects on patient neurocognitive function and quality of life as well as delay of potentially life-prolonging systemic therapies. An essential limitation of the Alliance trial raised by its authors involves the relatively worse surgical bed control after SRS than reported in previous series. When comparing the results of any retrospective analysis to those of prospective clinical trials, the issue of selection bias in the retrospective cohorts must be taken into consideration.
