Stereotactic radiosurgery and hypofractionated stereotactic radiotherapy: Normal tissue dose constraints of the central nervous system

Single-fraction stereotactic radiosurgery (SRS) and hypofractionated stereotactic radiotherapy (SRT) are radiation planning and delivery techniques used for the treatment of intracranial and spine/spinal cord tumors and targets. For cranial SRS and SRT, critical normal tissues/structures include the brainstem, cranial nerves, cochlea and normal brain parenchyma. For spine SRS/SRT, critical normal tissues/structures include the spinal cord, cauda equina as well as neighboring organs. This paper reviews clinical studies investigating central nervous system dose tolerances after cranial or spinal SRS/SRT. The impact of dose, volume, fractionation, and other relevant clinic-pathologic variables are discussed, as are limitations of the published data.