The radiosurgery fractionation quandary: single fraction or hypofractionation?

Journal Article (Journal Article)

Stereotactic radiosurgery (SRS), typically administered in a single session, is widely employed to safely, efficiently, and effectively treat small intracranial lesions. However, for large lesions or those in close proximity to critical structures, it can be difficult to obtain an acceptable balance of tumor control while avoiding damage to normal tissue when single-fraction SRS is utilized. Treating a lesion in 2 to 5 fractions of SRS (termed "hypofractionated SRS" [HF-SRS]) potentially provides the ability to treat a lesion with a total dose of radiation that provides both adequate tumor control and acceptable toxicity. Indeed, studies of HF-SRS in large brain metastases, vestibular schwannomas, meningiomas, and gliomas suggest that a superior balance of tumor control and toxicity is observed compared with single-fraction SRS. Nonetheless, a great deal of effort remains to understand radiobiologic mechanisms for HF-SRS driving the dose-volume response relationship for tumors and normal tissues and to utilize this fundamental knowledge and the results of clinic studies to optimize HF-SRS. In particular, the application of HF-SRS in the setting of immunomodulatory cancer therapies offers special challenges and opportunities.

Full Text

Duke Authors

Cited Authors

  • Kirkpatrick, JP; Soltys, SG; Lo, SS; Beal, K; Shrieve, DC; Brown, PD

Published Date

  • April 1, 2017

Published In

Volume / Issue

  • 19 / suppl_2

Start / End Page

  • ii38 - ii49

PubMed ID

  • 28380634

Pubmed Central ID

  • PMC5463582

Electronic International Standard Serial Number (EISSN)

  • 1523-5866

Digital Object Identifier (DOI)

  • 10.1093/neuonc/now301


  • eng

Conference Location

  • England