Stereotactic radiosurgery for intracranial malignancies.

Stereotactic radiosurgery has historically been used for arteriovenous malformations and benign tumors but has rather recently been used as a tool in the multimodality management of intracranial malignancies. Radiosurgery has been shown to be highly effective in the management of small metastatic brain tumors and has proven effective in controlling small brain metastases that progress after prior fractionated radiotherapy. The technique is also a reasonable, low morbidity alternative to surgical resection in the initial management of patients with solitary brain metastasis. In selected patients with small, relatively spherical, high-grade gliomas, radiosurgery appears to produce tumor control, survival, and toxicity similar to that of brachytherapy. However, compared with brachytherapy, radiosurgery has the advantage of lower initial morbidity, reduced hospital stay, reduced radiation exposure to personnel, and lower costs. Future clinical trials should further define dose-response relationships and the optimum role for radiosurgery in the management of malignant intracranial neoplasms.