Recent advances in radiosurgical management of brain metastases.

Stereotactic radiosurgery (SRS) has become a widely available treatment option for patients with brain metastases. Recent clinical trials suggest that SRS can be used without upfront whole brain radiotherapy (WBRT), resulting in several clinical dilemmas in the current daily practice of SRS. The proper patient selection for SRS or WBRT continues to evolve. Statistical models to predict when new brain metastases will occur as well as who will experience neurologic death have been developed. The optimization of imaging continues for both detection of brain metastases and response assessment. Larger brain metastases continue to pose a challenge to practitioners to find options to optimize the therapeutic ratio. The current review addresses the current state of the scientific literature for these clinical dilemmas.