Objective:

To synthesize evidence on the current landscape, including technological advancements and treatment strategies, and future directions of stereotactic radiotherapy (SRT) for brain metastases.

Key Findings:

• SRT is widely adopted for oligometastatic brain disease due to its high precision and local control rates, with specific histological types influencing outcomes.
• Combination of SRT with systemic therapies maintains high intracranial control without the cognitive decline associated with whole-brain radiotherapy (WBRT), particularly in melanoma and breast cancer.
• Histological type significantly influences treatment outcomes, with melanoma and breast cancer brain metastases showing distinct responses to SRT, necessitating tailored approaches.

Interpretation:

SRT represents a key component in the management of brain metastases, with ongoing research needed to optimize treatment based on tumor histology, including rare types, and advancements in systemic therapy.

Limitations:

• Current studies often include mixed histologies, complicating the extrapolation of results and necessitating careful consideration in treatment decisions.
• Data on rare tumor types and their response to SRT is limited, highlighting the need for further research.

Conclusion:

SRT is a critical tool in treating brain metastases, but further research is required to tailor approaches based on individual tumor characteristics, particularly for rare histologies, and systemic therapy advancements.