There are multiple published randomized controlled trials supporting single-fraction stereotactic radiosurgery (SF-SRS) for patients presenting with 1 to 4 brain metastases, with the benefit of minimizing radiation-induced neurocognitive sequelae as compared to whole brain radiotherapy . More recently, the dogma of SF-SRS as the only means of delivering an SRS treatment has been challenged by hypofractionated SRS (HF-SRS). The ability to deliver 25-35 Gy in 3-5 HF-SRS fractions is a direct consequence of the evolution of radiation technologies to allow image guidance, specialized treatment planning, robotic delivery and/or patient positioning corrections in all 6 degrees-of-freedom, and frameless head immobilization. The intent is to mitigate the potentially devastating complication of radiation necrosis and improve rates of local control for larger metastases. This narrative review provides an overview of outcomes specific to HF-SRS in addition to the more recent developments of staged SRS, preoperative SRS, and hippocampal avoidance-whole brain radiotherapy with simultaneous integrated boost.

有多项已发表的随机对照试验支持单次立体定向放射外科 (SF-SRS) 用于出现 1 至 4 个脑转移瘤的患者，与全脑放疗相比，可最大程度地减少辐射引起的神经认知后遗症。最近，大分割 SRS (HF-SRS) 挑战了 SF-SRS 作为提供 SRS 治疗的唯一手段的教条。在 3-5 HF-SRS 分次中提供 25-35 Gy 的能力是辐射技术发展的直接结果，允许在所有 6 个角度进行图像引导、专门治疗计划、机器人实施和/或患者定位校正。自由和无框头部固定。目的是减轻辐射坏死的潜在破坏性并发症，并提高对较大转移灶的局部控制率。除了分期 SRS、术前 SRS 和海马回避-全脑放疗同步综合推量的最新进展外，这篇叙述性综述还概述了 HF-SRS 的特定结果。