Stereotactic radiosurgery (SRS)
A single very precise, very high dose of radiation to a brain tumour or metastasis, aimed from many angles so the surrounding brain gets little; no scalpel is involved despite the name.
Gamma Knife, CyberKnife and linac-based SRS treat brain metastases up to about 3-4 cm (or several at once) with local control above 80% and have replaced whole-brain radiotherapy for limited disease because they spare cognition (N0574, JLGK0901). Larger cavities after surgery get fractionated stereotactic radiotherapy in 3-5 sessions. Modern practice combines SRS with CNS-active drugs (osimertinib, tucatinib, T-DXd), and trials now test whether upfront SRS can be deferred when such drugs are available.
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