Brain metastases (BM) affect approximately 20% to 40% of cancer patients and are associated with considerable morbidity and reduced survival. Stereotactic radiosurgery (SRS) has become a pivotal treatment option due to its ability to deliver high-dose, targeted radiation to brain lesions while minimizing exposure to surrounding healthy tissue. Unlike whole-brain radiation therapy (WBRT), which is linked to cognitive decline and suboptimal local control, SRS offers a more focused and effective approach, particularly in patients with a limited number of metastases.

One of the emerging areas of interest in SRS is dose escalation—administering higher radiation doses to improve local tumor control. While promising, this approach carries the risk of radiation-induced necrosis, highlighting the importance of defining safe thresholds for neurotoxicity. Recent studies suggest that carefully controlled dose escalation can lead to improved tumor suppression without significantly increasing adverse effects, especially when patient selection and lesion characteristics are properly considered.

This paper evaluates current evidence on dose escalation in SRS, drawing from recent data, including 2023 studies, to assess its impact on tumor control rates, overall treatment efficacy, and associated complications. The analysis underscores the need for continued refinement of SRS protocols, including personalized dosing strategies that balance maximal therapeutic benefit with minimal risk. Our findings contribute to the evolving framework for the management of brain metastases, supporting the strategic use of dose escalation in selected cases to enhance patient outcomes.