Stereotactic radiotherapy in brain metastases: SRS/FSRT paradox and preferences of radiation oncologists in Türkiye (TROD 10-010 study).

PURPOSE: Brain metastases (BM) are the most common intracranial malignancies. However, the lack of high-level evidence comparing single- and multi-fraction stereotactic radiotherapy (SRT) results in substantial practice variability. We aimed to assess fractionation preferences and clinical decision-making among radiation oncologists (ROs) in Turkey. MATERIALS AND METHODS: A 21-question nationwide survey was conducted among ROs performing stereotactic treatment for BM. Responses were analyzed by clinical experience (> 10 vs ≤ 10 years). RESULTS: A total of 111 ROs participated; 77% had > 10 years of experience. Linac-based SRS was most commonly used (84%). Although 42% favored preoperative SRS, only 12% implemented it. The main factors influencing the choice of SRS over WBRT were number (42%) and volume (33%) of metastases. Junior ROs prioritized lesion number, whereas senior ROs adopted a more multifactorial approach. Most participants used both SRS and FSRT (57%). Fractionation decisions were primarily driven by lesion volume (83%), proximity to organs at risk (76%), size (75%), and location (74%). SRS was preferred for smaller, peripherally located lesions without prior WBRT. CONCLUSION: Fractionation strategies vary widely and are influenced by clinical experience, underscoring the need for prospective evidence and standardized guidance.