Frameless LINAC-based stereotactic radiation therapy to brain metastasis resection cavity without whole-brain radiation therapy: A systematic review

Purpose: The aim of this systematic review was to summarize the findings from the published data of frameless stereotactic radiation therapy (RT) to the resection cavity delivered with nonrobotic linear accelerator in patients with brain metastases. Methods: The studies cited in this systematic review were identified through a search of the PubMed database, using the search terms: "stereotactic [Title/Abstract]" and " Brain [Title/Abstract]," and "Metas* [Title/Abstract]." The search was unlimited to language and publication year. Results: A total of 9 studies were included in our review. Stereotactic RT to the resection cavity appears to provide excellent local control rates that are comparable to framed stereotactic RT. There are various factors that influence local control. Distant intracranial control rates are poor with the use of postoperative stereotactic RT compared with local treatment (surgery or stereotactic RT) plus whole-brain RT. Conclusions: Stereotactic RT to the resection cavity appears to provide good local control rates and poor distant intracranial control. Postoperative treatment should be discussed by a multidisciplinary team and tailored to each case individually. Published by Elsevier Inc. on behalf of the American Society for Radiation Oncology.