KEY POINTS
- TROD 10-010 was a 21-question nationwide survey distributed to approximately 400 members of the Turkish Radiation Oncology Association who perform stereotactic brain metastasis treatment. 111 radiation oncologists responded, including 85 (77%) with >10 years of clinical experience and 26 with ≤10 years.
- Stereotactic treatment was predominantly linac-based. Overall, 84% reported using linac-based SRS either alone or alongside another platform. Most respondents used both single- and multifraction stereotactic treatment (57%), compared with 40% mainly using fractionated stereotactic RT and only 4% favoring single-fraction SRS alone.
- A clear preference-to-practice gap appeared for preoperative stereotactic RT. In the detailed results, 39% preferred a preoperative approach but only 11% actually used it. Among junior physicians, 42% preferred preoperative treatment but none performed it routinely; among senior physicians, 38% preferred it and 14% used it. Overall preference-versus-practice discordance was significant (p=0.004).
- When deciding between stereotactic treatment and whole-brain RT, the leading determinant was number of brain metastases in 42%, followed by total metastatic volume in 33%. Junior physicians relied on lesion number considerably more often than senior physicians (65% vs 35%; p=0.013).
- Fractionation itself was driven primarily by metastatic volume in 83%, proximity to organs at risk in 76%, lesion size in 75% and anatomical location in 74%. Single-fraction SRS was more commonly preferred for lesions <2 cm, volumes around 4–14 cm³, targets distant from critical structures and patients without previous whole-brain RT.
- OAR proximity produced the clearest experience-related difference in fractionation. For lesions adjacent to critical structures, 96.4% of senior versus 84.6% of junior physicians preferred multifraction treatment (p=0.007), and no senior respondent selected single-fraction SRS in that situation.
- The survey reflects stated preference, not audited patient-level treatment practice. Only 111 of approximately 400 eligible members responded, the junior subgroup contained just 26 physicians, institutional technology and caseload were incompletely captured, and the questionnaire was pilot-tested but not formally psychometrically validated.
CLINICAL TAKEAWAY
The survey illustrates why a simple “SRS or FSRT?” rule remains difficult: clinicians are integrating lesion size, volume, anatomy, prior RT and institutional realities differently. Particularly striking is the gap between enthusiasm for preoperative SRS and the ability to deliver it in routine practice, suggesting that workflow and multidisciplinary infrastructure may be as important as physician preference.