LATEST NEWS: 27 January 2026

New guidelines to ensure accuracy and quality in clinical trials using stereotactic radiosurgery (SRS) to treat brain metastases have been published, after being developed by a TROG Working Group.

The use of SRS for treating brain metastases has increased rapidly. SRS delivers very high radiation doses with minimal margins for error, placing significant demands on geometric and dosimetric accuracy across the entire treatment chain, including imaging, planning, immobilisation, treatment delivery and verification. These requirements create unique challenges for SRS quality assurance within clinical trials, particularly given the wide range of technologies used to deliver SRS.

The TROG SRS Technical Working Group, a sub-committee of the New Techniques and Technologies Committee (NTTC), was established to develop guidelines to support Trial Management Committees in defining appropriate SRS credentialing and quality assurance requirements for clinical trials.

The guidelines were developed collaboratively by experts from radiation oncology, medical physics, radiation therapy and the TROG Quality Assurance (QA) team over more than two years, in parallel with sites participating in two TROG trials:

• The TROG 16.02 – LOCAL HER-O trial in patients with breast cancer-related brain metastases
• The TROG 17.02 – OUTRUN trial in patients with non-small cell lung cancer-related brain metastases.

The Working Group’s recommendations, published in the Journal of Medical Imaging and Radiation Oncology in December 2025, provide recommendations covering areas including:

• Patient setup and immobilisation
• Pre-treatment imaging
• Treatment planning
• Treatment delivery systems
• Patient positional verification and correction.

While the guidelines focused on SRS credentialing for brain metastases, the recommendations could be applicable for other neurological diseases treated with SRS, the authors suggested.

Congratulations to the Working Group and collaborators on producing this valuable guidance for future trials.

• See the full paper in the Journal of Medical Imaging and Radiation Oncology
• Read more about TROG’s QA Policy, Guidelines and Credentialing for trials