Stereotactic radiotherapy in brain metastases: SRS/FSRT paradox and preferences of radiation oncologists in Türkiye (TROD 10-010 study)

Abstract

Purpose Brain metastases (BM) are the most common intracranial malignancies. However, the lack of high-level evidence comparing single- and multi-fraction stereotactic radiotherapy (SRT) results in substantial practice variability. We aimed to assess fractionation preferences and clinical decision-making among radiation oncologists (ROs) in Turkey. Materials and methods A 21-question nationwide survey was conducted among ROs performing stereotactic treatment for BM. Responses were analyzed by clinical experience (> 10 vs <= 10 years). Results A total of 111 ROs participated; 77% had > 10 years of experience. Linac-based SRS was most commonly used (84%). Although 42% favored preoperative SRS, only 12% implemented it. The main factors influencing the choice of SRS over WBRT were number (42%) and volume (33%) of metastases. Junior ROs prioritized lesion number, whereas senior ROs adopted a more multifactorial approach. Most participants used both SRS and FSRT (57%). Fractionation decisions were primarily driven by lesion volume (83%), proximity to organs at risk (76%), size (75%), and location (74%). SRS was preferred for smaller, peripherally located lesions without prior WBRT. Conclusion Fractionation strategies vary widely and are influenced by clinical experience, underscoring the need for prospective evidence and standardized guidance.