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Advances in Radiation Therapy for Brain Metastases

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

Deadline for manuscript submissions: 5 November 2026 | Viewed by 3219

Special Issue Editor


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Guest Editor
Hospital Universitario de Salamanca, Salamanca, Spain
Interests: brain tumors; brain metastasis; model development

Special Issue Information

Dear Colleagues,

Brain metastases develop in 20% to 40% of patients with cancer and can have a significant effect on patient survivorship because of the detrimental effects on neurocognitive function, neurologic symptoms, and survival. This Special Issue, “Advances in Radiation Therapy for Brain Metastases”,  will focus on recent developments in the management of patients with brain metastases, including advanced radiation therapy (RT) techniques such as stereotactic radiosurgery (SRS) and hippocampal avoidance whole brain radiation therapy (HA-WBRT) to reduce side effects of RT, and more sophisticated tools, like radiomics and/or artificial intelligence, to detect brain metastasis, to predict tumor control, to contribute efficiently to treatment planning, to differentiate tumor progression from radiation necrosis, and to estimate patient survival. Furthermore, advanced imaging with PET tracers and multiparametric magnetic resonance imaging could refine several steps of the RT process. Besides progress in RT, emerging systemic therapies such as targeted therapies and immunotherapy claim their role as alternatives or adjuncts to RT and should be integrated in the contemporary management of brain metastases. This Special Issue will address these topics by an international team of experts in the field.

Dr. Luis A. Pérez-Romasanta
Guest Editor

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Keywords

  • brain metastasis
  • metastatic brain tumor
  • imaging
  • radiotherapy
  • stereotactic radiosurgery
  • radiomics
  • machine learning
  • magnetic resonance imaging
  • positron emission tomography

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Published Papers (3 papers)

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Research

12 pages, 936 KB  
Article
Fractionated Stereotactic Radiotherapy to Resection Cavities Following Brain Metastasis Surgery: Clinical Outcomes and Challenges
by Paul Windisch, Robert Förster, Daniel R. Zwahlen and Christina Schröder
Cancers 2026, 18(2), 304; https://doi.org/10.3390/cancers18020304 - 19 Jan 2026
Viewed by 850
Abstract
Brain metastases (BMs) represent the most common intracranial malignancy in adults, affecting up to 50% of patients with solid tumours [...] Full article
(This article belongs to the Special Issue Advances in Radiation Therapy for Brain Metastases)
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12 pages, 308 KB  
Article
Cost-Effectiveness Analysis of an Intracranial Stereotactic Radiotherapy Service for Brain Metastasis in a North Queensland Regional Cancer Centre
by Qichen Zhang, Lan Gao, Neha Das, Timothy Squire, Daniel Stoker, Reshma Shakya, Deepti Patel, Abhishek Joshi and Tao Xing
Cancers 2026, 18(1), 163; https://doi.org/10.3390/cancers18010163 - 2 Jan 2026
Viewed by 1029
Abstract
Introduction: Intracranial stereotactic radiosurgery (SRS) is a specialised radiotherapy technique that plays an essential role in achieving local control of brain metastases and therefore optimising quality of life for many cancer patients. It also confers a survival benefit in selected patients. Rural and [...] Read more.
Introduction: Intracranial stereotactic radiosurgery (SRS) is a specialised radiotherapy technique that plays an essential role in achieving local control of brain metastases and therefore optimising quality of life for many cancer patients. It also confers a survival benefit in selected patients. Rural and regional Australians may face significant challenges in accessing this treatment, as it is predominantly delivered at metropolitan institutions. We sought to assess the cost-effectiveness of a brain SRS service implemented using local resources at a North Queensland regional hospital from a societal perspective. Methods: We prospectively collected treatment costs and clinical outcomes for a consecutive cohort of patients who received SRS for intracranial metastatic lesions at a regional cancer centre since the implementation of the brain SRS program in September 2022. We compared the healthcare and non-healthcare costs (e.g., travel and informal care) with the costs that would have otherwise been incurred if patients were referred to metropolitan centres in the state capital. Clinical outcomes incorporated overall survival, intracranial disease control rates, and incidence of radiation necrosis. Clinical outcome data of the metropolitan centres were derived from the published literature. Results: A total of 34 patients received treatment during the study period. Their median age was 65 years (range: 49–78 years). Around 47% received adjuvant SRS following surgical resection, and the remaining 53% were treated for intact brain metastases. The predominant primary malignancy was non-small cell lung cancer. The mean total cost per course of brain SRS at a regional hospital was AUD 6690, including AUD 5754 for healthcare and AUD 1682 for non-healthcare costs, across 34 patients recruited between September 2022 and August 2024. This was AUD 760 less than that of a course of treatment delivered at a metropolitan hospital. Median survival among the cohort was 15.7 months, and eight patients (24%) developed radionecrosis; these were comparable to published data reported by Australian urban and international institutions. Conclusions: The implementation of a brain SRS service at regional cancer centres utilising existing infrastructure and local expertise has the potential to offer cost-effective treatment to rural and regional cancer patients. This approach improves access for patients who might otherwise face logistics barriers and competing life priorities when seeking treatment in metropolitan centres. Full article
(This article belongs to the Special Issue Advances in Radiation Therapy for Brain Metastases)
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11 pages, 804 KB  
Article
Local Control After Single-Isocenter Dynamic Conformal Arc SRS for Brain Metastases
by Maciej Blok, Izabela Zarebska, Izabela Miechowicz, Tomasz Wisniewski, Szymon Ziolkowski and Maciej Harat
Cancers 2025, 17(22), 3711; https://doi.org/10.3390/cancers17223711 - 20 Nov 2025
Cited by 1 | Viewed by 781
Abstract
Purpose: Brain metastases occur in up to 30% of patients with advanced cancer and remain a major clinical challenge. While WBRT was historically the standard treatment, it provided limited survival benefit and significant neurocognitive toxicity, leading to increasing use of stereotactic radiosurgery (SRS). [...] Read more.
Purpose: Brain metastases occur in up to 30% of patients with advanced cancer and remain a major clinical challenge. While WBRT was historically the standard treatment, it provided limited survival benefit and significant neurocognitive toxicity, leading to increasing use of stereotactic radiosurgery (SRS). Recent advances with single-isocenter, multi-target (SIMT) dynamic conformal arc (DCA) techniques on modern linear accelerators have enabled efficient treatment of numerous lesions within a single session, though concerns regarding geometric accuracy persist. This study aimed to evaluate local control outcomes and influencing factors following DCA-SIMT radiosurgery in patients with multiple brain metastases. Methods: We retrospectively analyzed 195 brain metastases treated using single-isocenter, multi-target dynamic conformal arc (DCA-SIMT) stereotactic radiosurgery on a Varian TrueBeam LINAC between August 2018 and September 2020. Treatment planning was performed with Brainlab Elements MultiMets software, version 2.0 and image guidance with ExacTrac. Local control was assessed on MRI according to BM-RANO criteria, while radiation-induced contrast enhancements (RICE) were identified using multiparametric MRI. The median follow-up duration was 12 months. Statistical analyses included chi-square and ROC analyses, with p < 0.05 considered statistically significant. Results: A total of 195 brain metastases in 37 patients were analyzed. Local control at 6 months was achieved in 93% of lesions, with complete or partial response in 82%. Distance-to-isocenter (DTI), gradient index (GI), and target volume (GTV/PTV) were not associated with local control. In contrast, conformity index (CI) < 1.42 predicted better treatment response (AUC = 0.698, p = 0.0006). Margin expansion ≥ 0.5 mm was associated with improved local control (p = 0.049), while higher margins did not further improve outcomes. Prescription dose showed no significant impact. The addition of immunotherapy or targeted therapy within 4 months post-SRS significantly increased the likelihood of radiographic response (OR = 2.55, p = 0.030), with the strongest association observed in lung adenocarcinoma patients (p < 0.001). Conclusions: DCA-SIMT stereotactic radiosurgery achieves high local control in patients with multiple brain metastases. Conformity index, minimal margin expansion, and systemic therapy influenced outcomes, whereas distance-to-isocenter and dose did not. Further validation is needed to optimize margins in high-DTI scenarios. Full article
(This article belongs to the Special Issue Advances in Radiation Therapy for Brain Metastases)
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