ESTRO 2024 Congress report

This report provides a summary of the presentations made during ESTRO 2024 regarding stereotactic radiotherapy for Brain Metastasis.

In recent years, Stereotactic Radiosurgery (SRS) has emerged as an innovative treatment option for patients with brain metastases. This non-invasive, highly precise treatment option revolutionised the efficiency of brain metastasis therapy, with improved toxicity outcomes and optimal local control. This joint symposium was an excellent example of the multi-disciplinarity of this field, including talks from RTTs, Radiation Oncologists, Medical Physicists and Neuro-Oncologists.

In this direction, Aoife Williamson (consulting RTT), nicely emphasised the essential role of RTT in the treatment of brain metastasis using SRS/SRT. Specialised roles for Radiation Therapists have become pivotal in ensuring the effective implementation of SRS treatments. Their expertise in treatment planning and quality assurance plays a crucial role in optimising patient care and treatment outcomes, especially in the context of the current and constant advancements in SRS technology. The use of frame-less, LINAC-based techniques and the availability of advanced imaging techniques like CBCT and surface-guided systems, have significantly enhanced treatment accuracy and reduced treatment times.

Per Munck af Rosenschold offered, from a medical physics perspective, some insight on challenges and opportunities in this field. While SRS offers promising results with an improved therapeutic ratio, challenges such as defining optimal treatment margins and standardising protocols remain. Ongoing research and technological innovations, including automation in treatment planning and comprehensive data collection to refine treatment protocols and support evidence-based decision-making, present opportunities for further improvements.

Mentioning technological advancements, the introduction of MR-LINACs in the stereotactic radiotherapy treatments for brain metastasis, as well as MR-only workflows are at the forefront of the field, as highlighted by Maximilian Niyazi. Such developments are shown to enable timely, more precise, and personalised, adaptive treatments, for optimised patient outcomes. However, further research is needed to refine these methods and current efforts are focused towards improving the availability and accuracy of these techniques.

Last but not least, we were immersed in the world of clinical neuro-oncology, while Andrea Pace discussed the critical consideration of cognitive and neurological effects associated with brain tumour therapy, including radiotherapy. He emphasised that research efforts should focus on mitigating these impacts through advanced treatment planning and pharmacotherapy, as well as other cognitive rehabilitation strategies and early intervention.

In conclusion, the integration of advanced SRS/SRT technologies in the treatment of brain metastasis not only enhances treatment precision but also presents challenges in ensuring standardised treatments and optimising patient-specific outcomes. Collaboration among multidisciplinary teams is crucial for leveraging these effectively. As advancements continue, the focus remains on enhancing treatment outcomes, minimising side effects, and improving the quality of life for patients undergoing SRS treatment for brain tumours.

Andrada Turcas

Radiotherapy Department

The Oncology Institute “Prof. Dr. Ion Chiricuta”

Cluj-Napoca, Romania