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New Advances in Stereotactic Radiosurgery
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New Advances in Stereotactic Radiosurgery

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Oncology".

Deadline for manuscript submissions: 24 December 2025 | Viewed by 869

Special Issue Editor

Dr. Shafak S. Aluwini

E-Mail Website
Guest Editor
Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
Interests: brachytherapy; radiosurgery; IMRT; prostate cancer; stereotactic radiosurgery; dose fractionation

Special Issue Information

Dear Colleagues,

Stereotactic radiosurgery (SRS) has revolutionized the treatment of various intracranial and extracranial pathologies, offering a non-invasive, highly precise modality that delivers high doses of radiation to well-defined targets while sparing surrounding healthy tissue. Over the past decade, advances in imaging, radiation delivery systems, and treatment planning algorithms have significantly enhanced the efficacy and safety of SRS. These developments have broadened its clinical applications, ranging from the management of brain metastases, arteriovenous malformations, and functional disorders to emerging uses in spinal and extracranial tumors.

Recent innovations in SRS include the integration of advanced imaging modalities, such as functional MRI and PET, for improved target delineation and adaptive radiotherapy systems that account for real-time tumor and organ motion. Moreover, novel delivery platforms, such as linear accelerators with image-guided capabilities, Gamma Knife systems, and robotic radiosurgery devices like CyberKnife, have enhanced precision and expanded treatment possibilities. Concurrently, research into the radiobiological mechanisms underlying SRS has refined fractionation strategies and improved patient outcomes.

This Special Issue aims to highlight cutting-edge advancements in SRS, with a focus on technological breakthroughs, clinical outcomes, and future directions. By synthesizing the latest evidence, this collection will provide a comprehensive overview of the evolving role of SRS in modern therapeutic paradigms.

Dr. Shafak S. Aluwini
Guest Editor

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Keywords

  • stereotactic radiosurgery
  • clinical outcomes
  • brachytherapy
  • IMRT
  • brain metastases
  • arteriovenous malformations
  • functional disorders
  • radiosurgery

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Published Papers (2 papers)

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10 pages, 1087 KB  
Article
Optimizing SRS for Brain Metastases: Understanding the Volume–Gradient Index Relationship
by Tia Popescu-Bârhală, Ionuţ Dumitru, Mihai-Ştefan Bârhală and Horia-Dan Lişcu
J. Clin. Med. 2025, 14(22), 8123; https://doi.org/10.3390/jcm14228123 - 17 Nov 2025
Viewed by 307
Abstract
Background/Objectives: The goal is to provide a straightforward framework for generating SRS-SRT plans that reliably meet high-quality dosimetric standards. That posed some questions such as which plan quality metrics should be utilized to evaluate a plan, what influences plan quality metrics the [...] Read more.
Background/Objectives: The goal is to provide a straightforward framework for generating SRS-SRT plans that reliably meet high-quality dosimetric standards. That posed some questions such as which plan quality metrics should be utilized to evaluate a plan, what influences plan quality metrics the most, and finally, how to best optimize plan geometry. Our work has primarily concentrated on the second question, guided by our clinical experience. Methods: A dataset for statistical analysis was compiled by retrospectively reviewing 200 individual SRS-SRT target volumes from two centers. From the gathered data, several Linear Regression models were generated to assess the variability of plan quality metrics using statistical analysis. The most important regressor in the models were revealed to be target volume (TV), followed by a flag type variable that indicates whether the plan used to treat the referenced target contained multiple targets (MT) or not. Results: Every doubling of TV lowers Gradient Index (GI) sharply (−0.55 to −0.17) while Gradient Measure (GM) increases moderately (+0.024 cm to +0.07 cm). The model explains 85% of the variation in GI (R2 = 0.85) and 84% of GM. Conclusions: In small lesions, GI seems to be a more sensitive evaluation metric for sub-CC SRS targets, compared to GM. Dose per fraction appeared to have had no significant effect. Treating multiple targets in the same plan appears to add an average of +0.19 to GI, independent of volume, while for GM by +0.027 cm. Full article
(This article belongs to the Special Issue New Advances in Stereotactic Radiosurgery)
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13 pages, 8795 KB  
Brief Report
Safety and Effectiveness of Volumetric Modulated Arc Therapy-Based Stereotactic Radiosurgery for Posterior Fossa Brain Metastases: A Single-Centre Experience
by José Manuel Sánchez-Villalobos, Alfredo Serna-Berna, Juan Salinas-Ramos, Pedro Pablo Escolar-Pérez, Ginés Luengo-Gil, Marina Andreu-Gálvez, Emma Martínez-Alonso and Miguel Alcaraz
J. Clin. Med. 2025, 14(23), 8540; https://doi.org/10.3390/jcm14238540 (registering DOI) - 2 Dec 2025
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Abstract
Background/Objectives: Posterior fossa brain metastases (PFBMs) pose particular risks owing to their proximity to the brainstem and fourth ventricle. We evaluated the safety (treatment-related complications), local effectiveness, and procedural efficiency of volumetric modulated arc therapy (VMAT)-based stereotactic radiosurgery (VMAT-SRS) for PFBMs. Methods: [...] Read more.
Background/Objectives: Posterior fossa brain metastases (PFBMs) pose particular risks owing to their proximity to the brainstem and fourth ventricle. We evaluated the safety (treatment-related complications), local effectiveness, and procedural efficiency of volumetric modulated arc therapy (VMAT)-based stereotactic radiosurgery (VMAT-SRS) for PFBMs. Methods: This single-centre, retrospective study derived a PFBM subgroup from an overall institutional cohort of 123 patients treated with VMAT-RapidArc SRS/fSRS. The doses were 12–20 Gy (single fraction) or 5 × 6 Gy (selected cases). Local response (mRECIST) and predefined safety endpoints (symptomatic oedema with brainstem/IV-ventricle compromise, obstructive hydrocephalus, haemorrhagic transformation, CSF diversion, and urgent neurosurgery) were assessed. Overall survival and procedural time were analysed. Results: Thirty-one patients (39 lesions) were included; 76.9% of them received single-fraction SRS. In addition, 74.2% of patients had supratentorial metastases with posterior fossa involvement. Kaplan–Meier overall survival at 6, 12, 24, and 48 months was 74%, 58%, 26%, and 9.7%, respectively; the median survival time was 12.6 months. Among evaluable lesions, local control was 84.5% (per-lesion response: 15.5% PD, 28.1% SD, 34.4% PR, and 22.0% CR). No clinically significant posterior fossa local complications were observed. Three patients developed radiation-induced leukoencephalopathy after whole-brain radiotherapy (WBRT) and radiosurgery for synchronous supratentorial metastases. The median procedural time was 25.0 min (IQR 9.0) with one isocentre versus 52.5 min (IQR 9.75) with two. Conclusions: VMAT-SRS/fSRS for PFBMs achieved high local control, very low posterior fossa toxicity, and favourable procedural efficiency, supporting its use as a safe, rapid, frameless alternative to WBRT and other radiosurgical platforms such as Gamma Knife in appropriately selected patients. Full article
(This article belongs to the Special Issue New Advances in Stereotactic Radiosurgery)
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