Submit to Special Issue Submit Abstract to Special Issue Review for Cancers Propose a Special Issue

Journal Menu

Journal Browser

► Journal Browser

Radiosurgery for Brain Tumors

Print Special Issue Flyer
Special Issue Editors
Special Issue Information
Keywords
Benefits of Publishing in a Special Issue
Published Papers

A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Cancer Therapy".

Deadline for manuscript submissions: 31 July 2026 | Viewed by 12883

Share This Special Issue

Special Issue Editor

Dr. Anna Petoukhova

E-Mail Website
Guest Editor

Department of Medical Physics, Haaglanden Medical Center, 2262 BA Leidschendam, The Netherlands
Interests: photon and proton radiotherapy; radiosurgery; linac-based stereotactic radiotherapy multiple brain metastases

Special Issue Information

Dear Colleagues,

The incidence of cancer is increasing worldwide. As a noninvasive alternative to surgery, radiosurgery uses high-energy X-rays or protons to destroy tumors. As one of the treatment modalities, radiosurgery plays a crucial role in managing malignant brain tumors. Radiosurgery can also be used for the effective treatment of benign brain tumors such as meningiomas or pituitary adenoma.

Stereotactic radiosurgery (SRS) uses many precisely focused radiation beams for the accurate targeting of tumors while minimizing damage to the surrounding organs at risk, such as healthy brain tissue, brain stem, chiasm, optic nerves, eyes, the cochlea, and pituitary gland. Nowadays, magnetic resonance imaging (MRI) has significantly improved the delineation of brain tumors and has allowed for progress to be made in terms of irradiation using magnetic resonance linac (MRL).

We cordially invite you to submit your cutting-edge research and review articles to this Special Issue, which aims to encompass new research articles and timely reviews on all aspects of brain tumors’ radiosurgery treatment with photons or protons.

Dr. Anna Petoukhova
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Cancers is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

radiosurgery with photons and protons
stereotactic radiosurgery (SRS)
brain tumors
gliomas
meningioma
pituitary adenoma
magnetic resonance imaging (MRI)
magnetic resonance linac (MRL)

Benefits of Publishing in a Special Issue

Ease of navigation: Grouping papers by topic helps scholars navigate broad scope journals more efficiently.
Greater discoverability: Special Issues support the reach and impact of scientific research. Articles in Special Issues are more discoverable and cited more frequently.
Expansion of research network: Special Issues facilitate connections among authors, fostering scientific collaborations.
External promotion: Articles in Special Issues are often promoted through the journal's social media, increasing their visibility.
Reprint: MDPI Books provides the opportunity to republish successful Special Issues in book format, both online and in print.

Further information on MDPI's Special Issue policies can be found here.

Published Papers (5 papers)

Download All Papers

Order results

Result details

Show export options Show export options

Select all

Export citation of selected articles as:

Research

Jump to: Review

13 pages, 2619 KB

Open AccessArticle

Balancing Conformity and Low-Dose Brain Exposure Across Gamma Knife and Linac-Based Stereotactic Radiosurgery Techniques for Multiple Brain Metastases

by Cristina Teixeira, Orbay Askeroğlu, Marlies Boussaer, Sven Van Laere, Selçuk Peker, Mark De Ridder and Thierry Gevaert

Cancers 2026, 18(7), 1113; https://doi.org/10.3390/cancers18071113 - 30 Mar 2026

Cited by 1 | Viewed by 509

Abstract

Background/Objectives: LINAC-based single-isocenter (SIT) stereotactic radiosurgery (SRS) enables efficient treatment of multiple brain metastases but may compromise target conformity and increase low-dose brain exposure, particularly for spatially distributed lesions. Dual-isocenter techniques (DITs) may mitigate these limitations, while Gamma Knife (GK) remains the reference standard for high-selectivity radiosurgery. This study compares SIT- and DIT LINAC-based SRS with GK, focusing on target conformity and low-dose brain exposure under equivalent, zero-margin targeting assumptions. Methods: Twenty-eight patients with multiple brain metastases (197 lesions) were included in this retrospective planning study. For each patient, three plans were generated: a GK plan and LINAC-based SIT and DIT plans using automated dynamic conformal arc optimization (Elements Multiple Brain Metastases). All plans were generated using a zero-millimeter GTV-to-PTV margin strategy. For DIT, lesions were automatically clustered and assigned to two isocenters. Target coverage required ≥99% of each GTV to receive the prescription dose. Plan quality was evaluated using the Paddick Conformity Index (PCI) on a per-lesion basis and low-dose brain volumes (V12, V10, V5, V4, and V3 Gy) on a per-patient basis. Paired non-parametric tests and multivariable models were used to assess technique-related differences and associations with total target volume and lesion count. Results: GK achieved the highest median PCI (0.83), followed closely by DIT (0.77), while SIT plans demonstrated significantly lower conformity (0.73). Compared with GK, the median PCI difference was −0.05 for DIT and −0.08 for SIT. Conformity for DIT remained stable across lesion volumes and lesion counts, whereas GK conformity increased modestly with lesion size. Low-dose brain exposure differed significantly between techniques at all dose levels (p < 0.001). GK consistently yielded the lowest Vx volumes, SIT the highest, and DIT intermediate values. Relative to GK, SIT plans showed progressively larger increases in low-dose exposure at lower dose levels (mean ΔV3 ≈ +149 cc), while DIT reduced this low-dose spread (mean ΔV3 ≈ +117 cc). Total target volume was the dominant predictor of low-dose brain exposure across all techniques, with a smaller additional contribution from lesion count. Conclusions: DIT LINAC-based SRS significantly improves target conformity and reduces low-dose brain exposure compared with SIT delivery, achieving dosimetric performance that closely approximates Gamma Knife under equivalent zero-margin targeting assumptions. While Gamma Knife remains the reference standard for low-dose sparing, dual-isocenter planning represents a clinically robust and scalable alternative that effectively balances plan quality and treatment efficiency in patients with multiple brain metastases. Full article

(This article belongs to the Special Issue Radiosurgery for Brain Tumors)

► Show Figures

Figure 1

20 pages, 2996 KB

Open AccessArticle

High-Dose Stereotactic Re-Irradiation of Recurrent High-Grade Gliomas: Clinical Outcome and Experience with AI-Based Target Volume Simulation

by Anton Früh, Franziska Loebel, Bohdan Bodnar, Larissa Kilian, Martin Misch, Goda Kalinauskaite, Anne Kluge, Chiara Eitner, Julia Onken, Kerstin Rubarth, Daniel Zips, Peter Vajkoczy, Carolin Senger and Güliz Acker

Cancers 2025, 17(21), 3423; https://doi.org/10.3390/cancers17213423 - 24 Oct 2025

Cited by 1 | Viewed by 2153

Abstract

Background/Objectives: Despite multimodal therapeutic concepts, treatment of recurrent malignant gliomas remains challenging. Stereotactic radiosurgery (SRS) may be a possible safe and effective non-invasive salvage treatment. In this study, we aim to investigate the SRS treatment outcomes using partly 18F-Fluorethylthyrosine (FET)-PET-imaging sequences for SRS treatment planning focusing on overall survival, event-free survival, and the incidence and factors influencing radiation necrosis (RN) occurrence. Additionally, we evaluated the potential application of AI-based tumor segmentation. Methods: We conducted a retrospective analysis of patients with recurrent malignant glioma treated with single-fraction or hypofractionated SRS at our institution. The outcomes assessed included local control, overall survival (OS), and local event-free survival (LEFS, defined as the interval until tumor recurrence or the onset of RN). We also performed a simulation analysis to assess the potential of AI-based tumor segmentation. Results: The study included 27 patients with a median age of 57 years and 41 lesions. The median OS post-SRS was 9.6 months and an LEFS of 5.2 months. Factors positively influencing OS and LEFS included the gross tumor volume (GTV) of the lesions before SRS therapy, presence of an IDH mutation, and lomustine treatment post-SRS. The incidence of RN post-SRS was 31.7%. RN was confirmed histopathologically in 15.4%, based on MRI in 46.2% and by FET-PET in 38.5% of lesions. In a simulation analysis, AI-based tumor segmentation reliably delineated all lesions, requiring only minimal manual adjustments to define target volumes. Conclusions: High-dose SRS is a feasible salvage treatment for small-volume recurrent high-grade gliomas, achieving local control and survival outcomes comparable to other re-irradiation strategies. IDH mutation, smaller tumor volume, and lomustine therapy were associated with improved survival. RN occurred frequently, particularly in periventricular lesions. AI-based tumor segmentation showed promise in well-defined satellite recurrences, but remains limited in cavity-adjacent lesions, underlining the need for expert review and ¹⁸FET-PET imaging. Full article

(This article belongs to the Special Issue Radiosurgery for Brain Tumors)

► Show Figures

Figure 1

12 pages, 445 KB

Open AccessArticle

Stereotactic Radiosurgery for Patients with Brain Metastases from Sarcomas

by Andrew Hoang, Zhishuo Wei, Constantinos G. Hadjipanayis, Ajay Niranjan and L. Dade Lunsford

Cancers 2025, 17(13), 2118; https://doi.org/10.3390/cancers17132118 - 24 Jun 2025

Cited by 2 | Viewed by 2727

Abstract

Purpose: We present our single-institution experience of sarcomatous brain metastasis patients who underwent stereotactic radiosurgery (SRS) over the past 35 years. Methods: In total, 31 patients (16 males) who underwent SRS for sarcoma brain metastases were identified. Median age at presentation to SRS was 47 (range: 4–78) months. Common histopathologies included leiomyosarcoma (eight patients), osteosarcoma (six patients), alveolar sarcoma (three patients), Ewing sarcoma (three patients), and undifferentiated/unclassified sarcoma (three patients). The median Karnofsky Performance Score (KPS) was 90. Nine patients underwent pre-SRS craniotomy. The median dose prescribed was 18 Gy. The median cumulative tumor volume was 1.4 cc. Results: Median patient overall survival (OS) after SRS was 7 (range: 0–155) months. Local tumor control (LTC) was achieved in 105 out of 113 tumors, at a median time of 3 (range: 0–17) months between SRS and progression. LTC rates per patient and per tumor were 74.2% and 92.9%, respectively. Following SRS, 10 patients (32.3%) developed new tumors at a median time of 6 (range: 1–25) months. Four patients experienced adverse radiation effects (AREs). At the last follow-up, all patients died, one patient from intracranial progression, 27 from systemic disease progression, and the remaining from unrelated medical conditions. Conclusions: Given high LTC and low ARE rates, this suggests SRS as a strong candidate for the non-invasive management of sarcomatous brain metastases, which typically present late following initial presentation of the primary disease. Full article

(This article belongs to the Special Issue Radiosurgery for Brain Tumors)

► Show Figures

Figure 1

14 pages, 696 KB

Open AccessArticle

Patterns of Recurrence After Postoperative Stereotactic Radiotherapy for Brain Metastases

by Jeroen A. Crouzen, Anna L. Petoukhova, Martijn Hakstege, Elise E. M. W. van Schaik, Rishi D. S. Nandoe Tewarie, Rob J. A. Nabuurs, Maaike J. Vos, Melissa Kerkhof, Thijs van der Vaart, Johan A. F. Koekkoek, Rogier E. Hagenbeek, Fatih M. Yildirim, Lisette M. Wiltink, Noëlle C. M. G. van der Voort van Zyp, Mandy Kiderlen, Marike L. D. Broekman, Mirjam E. Mast and Jaap D. Zindler

Cancers 2025, 17(9), 1557; https://doi.org/10.3390/cancers17091557 - 3 May 2025

Cited by 2 | Viewed by 2182

Abstract

Background/Objectives: Neurosurgical resection is the standard treatment for large brain metastases (BMs). Postoperative stereotactic radiotherapy (SRT) is used to reduce local recurrence (LR) but does not always prevent leptomeningeal disease (LMD). This study aims to analyze patterns of tumor recurrence and to identify opportunities for the further improvement of treatment efficacy. Methods: We included 147 patients who underwent resection and SRT for BMs. The distance between the resection cavity target volume and the new tumor growth was calculated. Cox regression analyses were used to assess associations of LMD with various patient characteristics. Results: Median survival after postoperative SRT was 14 months (IQR 6–30) with a 3-year actuarial survival rate of 21%. LR occurred in 20/147 patients (14%). After total resection, LR occurred in 21% of patients after 3 years of follow-up compared to 36% after subtotal resection. Marginal LR occurred in 5/147 patients (3%). LMD was found in 21/147 patients (14%; 3-year actuarial rate, 26%), and it was found more commonly in patients with resected cerebellar metastases (23%; 3-year actuarial rate, 46%) compared to those with cerebral metastases (11%; 3-year actuarial rate 17%) (HR 2.54, 95% CI 1.07–6.04, p = 0.034). Conclusions: This study examined patterns of recurrence after postoperative radiotherapy and its implications for radiation dose, radiation field size, and treatment sequence. Local control was high after total resection. Radiation field size appeared adequate given the low incidence of marginal recurrences. Patients with cerebellar metastases showed an increased risk of LMD, underscoring the need for preventive measures, particularly preoperative SRT. Full article

(This article belongs to the Special Issue Radiosurgery for Brain Tumors)

► Show Figures

Figure 1

Review

Jump to: Research

11 pages, 466 KB

Open AccessReview

Hypo-Fractionated Stereotactic Radiosurgery for the Management of Brain Metastases

by Stylianos Pikis, Georgios Mantziaris, Kimball Sheehan, Darrah Sheehan and Jason P. Sheehan

Cancers 2025, 17(18), 3026; https://doi.org/10.3390/cancers17183026 - 16 Sep 2025

Cited by 1 | Viewed by 4510

Abstract

The increasing prevalence of brain metastases in cancer patients due to longer life expectancy and improvements in neuroimaging highlights the need for effective local treatments. Despite advancements in systemic targeted therapies, their low blood–brain barrier (BBB) penetrance limits their intracranial efficacy. Stereotactic radiosurgery (SRS) has largely supplanted whole-brain radiation therapy (WBRT) for patients with up to 10 brain lesions due to superior neurocognitive outcomes and high local control. While single-fraction SRS provides low radiation toxicity with smaller lesions, high-volume metastases necessitate doses above tolerance limits to achieve comparable local control. As tumor volume increases, the number of tumor cells also increases, requiring higher doses of radiation than the maximum tolerated doses reported in the RTOG 9005 study to achieve tumor control. Hypo-fractionated SRS (HySRS) permits the delivery of high radiation doses over 2–5 fractions, thus mitigating the risk of radiation toxicity while maintaining high local control. This review presents the available evidence and ongoing clinical trials on HySRS for the management of brain metastases. Full article

(This article belongs to the Special Issue Radiosurgery for Brain Tumors)

► Show Figures

Journal Menu

Journal Browser

Radiosurgery for Brain Tumors

Share This Special Issue

Special Issue Editor

Special Issue Information

Keywords

Benefits of Publishing in a Special Issue

Published Papers (5 papers)

Research

Review

Further Information

Guidelines

MDPI Initiatives

Follow MDPI