Peer-reviewed journal article

Comparison of dose escalation using intraoperative radiotherapy (IORT)

Compared to post-operative stereotactic radiosurgery (SRS) after large brain metastases resection

9 September 2019 · 8 min read
Author Christopher P. Cifarelli, MD, PhD, FAANS, FACS Director of Gamma Knife Radiosurgery, Assistant Professor of Neurosurgery, WVU Cancer Institute, West Virginia University Hospital, Morgantown, USA

Reading this brief overview does not substitute the reading of the original study, but is just giving an abridged insight and is not necessarily reflecting the opinion of notified bodies and/or regulatory authorities, such as the DQS or FDA.


A brief overview of the dose escalation comparison of IORT and SRS created by Christopher P. Cifarelli, MD, PhD, FAANS, FACS on behalf of ZEISS, March 2019.

Original title:

Feasibility of dose escalation using intraoperative radiotherapy following resection
of large brain metastases compared to post-operative stereotactic radiosurgery.


John A. Vargo, Kristie M. Sparks, Rahul Singh, Geraldine M. Jacobson, Joshua D. Hack,
Christopher P. Cifarelli


Vargo, J.A., Sparks, K.M., Singh, R. et al. J Neurooncol (2018) 140: 413.

  • In oncology patients, the most common intracranial malignancy, accounting for significant morbidity and mortality are brain metastases.1
  • For the treatment stereotactic radiosurgery (SRS) is normally used, but as this frequently leads to radiation necrosis for larger brain metastases the dose level is limited and mostly the treatment volume is reduced with debulking surgery to enable SRS to deliver an adequate dose.
  • Intraoperative radiotherapy (IORT) might be a treatment alternative but so far standardized dose recommendations are not available.

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