REVIEW article
Front. Oncol.
Sec. Radiation Oncology
Stereotactic Radiotherapy for Brain Metastases: Indications, Dose Fractionation, Technological Innovations, and Evolving Combination Strategies – A Comprehensive Review
- HC
Hu Chen 1
- SL
Shuai Li 1
- QY
Qiuyu Yang 2
- FZ
Fangzheng Zhou 1,2
1. Luohu District Hospital of Traditional Chinese Medicine, Shenzhen, China
2. Shenzhen Luohu Hospital Group Luohu People's Hospital, Shenzhen, China
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Abstract
The incidence of brain metastases in cancer patients is increasing due to improved survival from systemic therapies and advancements in diagnostic imaging. Radiotherapy remains a cornerstone in the management of brain metastases. Among the various techniques, stereotactic radiotherapy (SRT) is widely adopted in multidisciplinary treatment owing to its high precision, rapid dose fall-off, high rates of local control, and superior preservation of neurocognitive function. In recent years, significant progress has been made in several areas of SRT, including technological advancements in equipment and radiation quality, its combination with surgery (either pre-or post-operatively), integration with systemic therapy (such as targeted and immunotherapy), and the exploration of new indications (e.g., more than 4 brain metastases, small cell lung cancer). Furthermore, optimization of dose fractionation regimens—including fractionated SRT, low-dose radiotherapy, exploration of maximum tolerated doses, and individualized ultrafractionated adaptive radiotherapy—has been actively investigated. This review synthesizes the evidence from classical literature and recent clinical studies to outline the current landscape and future directions of SRT for brain metastases.
Summary
Keywords
Advance, brain metastases, Combined Modality Therapy, stereotactic radiotherapy, Stereotactic Radiotherapy Equipment
Received
03 March 2026
Accepted
03 April 2026
Copyright
© 2026 Chen, Li, Yang and Zhou. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Fangzheng Zhou
Disclaimer
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