Shifting paradigms: whole brain radiation therapy versus stereotactic radiosurgery for brain metastases.

Management of intracranial metastases with radiation has historically been performed with whole brain radiation therapy (WBRT), which encompasses the entire brain, treating both visible and potentially microscopic disease [1]. In 1961, a Swedish neurosurgeon, Lars Leksell introduced the concept of stereotactic radiosurgery (SRS), in which a high dose of radiation could be delivered to a solitary lesion in a single treatment [2]. The concept of SRS, which has since become standard practice at many institutions, is to deliver higher dose per treatment for better disease control with minimal effect on normal brain tissue, leading ultimately to improved cognitive outcomes. This article will evaluate the shift in intracranial radiation from WBRT to SRS.