The Art of Radiation Therapy: The Necessary Risk of Radiation Necrosis for Durable Control of Brain Metastases

One of the greatest challenges in radiation oncology is selecting the “optimal” radiation dose and weighing the benefits and risks of our choices. Higher doses generally increase both tumor control probability (TCP) and normal tissue complication probability (NTCP). Finding the sweet spot, optimizing TCP with a clinically acceptable NTCP, is often difficult. An excellent example of this delicate balance is in the treatment of brain metastases with stereotactic radiosurgery (SRS), that is, weighing the benefits of local control with the risks of symptomatic radionecrosis.