Intraoperative Brachytherapy for Resected Brain Metastases

Brain metastases are the most common intracranial malignancies in adults. Surgical resection is the preferred treatment approach when a pathological diagnosis is required or for large symptomatic lesions. Radiotherapy is administered to improve local control rates following surgical resection. After a brief review of the literature describing the treatment of brain metastases using whole brain radiotherapy, postoperative stereotactic radiosurgery, preoperative radiosurgery, and intraoperative interstitial and intracavitary brachytherapy, we center our discussion on comparing the patient-related, technical, practical, and radiobiological considerations of each technique. Finally, we focus on the rationale, technique, evidence, and future directions regarding intraoperative brachytherapy as an underutilized technique with promising outcomes.