Judicious and evidence-based use of radiosurgery - recommendations for low- middle income countries

Abstract

Surgical removal remains the primary treatment for most
brain tumours. However, radiosurgery presents an
effective, less invasive alternative or additional treatment
for certain types. Our goal was to explore radiosurgery's
roles in treating various brain tumours, focussing on its
application in low- and middle-income countries (LMICs).
We reviewed all relevant systematic reviews, metaanalyses,
and guidelines to determine the most effective
radiosurgical approaches. Additionally, we consulted a
panel of experts with over ten years of experience in
LMICs, such as Pakistan. For brain tumours, stereotactic
radiosurgery should generally follow a confirmed
histopathological diagnosis. Exceptions include tumours
identified through Magnetic Resonance Imaging (MRI),
like Vestibular Schwannoma (VS), pre-diagnosed
Neurofibromatosis type 2 (NF2), multiple typical
meningiomas, and metastases with a known histology
from another site. While radiosurgery is gaining traction
as a primary and adjunct treatment in some LMICs, the
lack of regional guidelines, trained personnel, and
collaboration among specialists hinders its wider
adoption. Addressing these gaps is crucial for expanding
radiosurgical care in these regions.
Keywords: Meningeal neoplasms, neurofibromatosis,
neuroma, acoustic, meningioma,
Radiosurgery, brain neoplasms, magnetic resonance
imaging, pituitary tumour, glioma, vestibular
schwannoma.