ISRS Technical Guidelines for Stereotactic Radiosurgery: Treatment of Small Brain Metastases (≤1 cm in Diameter)

The objective of this literature review was to develop International Stereotactic Radiosurgery Society (ISRS) consensus technical guidelines for the treatment of small, ≤1 cm in maximal diameter, intracranial metastases with stereotactic radiosurgery (SRS). Although different SRS technologies are available, most of them have similar treatment workflows and common technical challenges that are described. According to a systematic review of the literature, we present a summary of the latest evidence supporting our recommendations for best practice. In addition, several consensus statements from the ISRS guidelines committee are provided based on a patterns of practice questionnaire specifically focused on imaging specifications, target volume delineation and localisation practices, use of margins, treatment planning techniques and patient positioning.