Confronting ethical challenges and guideline deviations in neuro-oncological radiosurgery

Abstract

Stereotactic radiosurgery (SRS) has transformed neurooncological
care through its precision, minimally invasive
nature. SRS involves multiple, convergent beams of high
energy gamma rays, X-rays, or protons at a precisely
defined treatment area. As the use of SRS continues to
grow in neuro-oncology, it has brought with it a range of
ethical and clinical concerns. This narrative review
examines how deviations from accepted clinical
guidelines and inappropriate use of SRS—such as overuse
in low-volume centers, financial motivations, poor
compliance with protocols, and unsuitable patient
selection—can lead to compromised patient care. These
practices not only pose risks to patient safety and
outcomes but also threaten to undermine trust in the
medical system. By reviewing real-world examples, this
review highlights the necessity of stronger
multidisciplinary decision-making, improved oversight
and training of the clinical teams involved in delivering
SRS. Addressing these issues is essential to ensure that
radiosurgery remains a safe, effective, and ethically sound
treatment option in the neuro-oncology practice.
Keywords: Steriotactic Radiosurgery, Radiation Therapy,
Brain Tumour, Brain Metastases.