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Protect motor, sensory and cognitive functions in brain tumor treatment.
In high-grade glioma, MR-guided adaptive radiotherapy spares 71% more healthy brain tissue than standard margins.1
A growing global challenge
Brain tumors affect more than 320,000 people each year, with nearly 250,000
deaths worldwide. For many patients, radiosurgery and radiotherapy are the
most effective and least invasive options. Adaptive treatments offer a
personalized approach, bringing safer, more effective care to more
patients.2
Proven precision, smarter protection
Key clinical evidence shows that adaptive radiosurgery and radiotherapy
enables accurate, personalized treatment for brain tumors, maximizing
target coverage while protecting critical structures.
3 cm tumor change
Glioblastomas can shrink or shift by as much as 3 cm over the course
of treatment due to edema, tumour regression, or edema, underscoring
the need for adaptive radiotherapy to keep pace with these
changes.3
Tumor progression during delays
A two-week gap between imaging and treatment led to new brain
metastases in 50% of patients and tumor growth in 75% with longer
delays linked to greater increases.4
Improved sparing of motor, sensory and neurocognitive function
Radiosurgery for multiple brain metastases can support stabilize and
even improve cognitive function.5
How adaptive radiotherapy helps you respond to clinical changes
Your challenge
Adaptive helps you...
Anatomy changes during the treatment course
Re-optimize daily treatment to stay on target and reduce unwanted
dose to healthy tissue
Tumors shrink or move between treatment sessions
Adjust treatment plan based on the image at the time of treatment
Escalating dose without treating organs at risk
Achieve greater certainty of patient position and adapt to what
you can see on the day
Quick replanning for scan-plan-treat workflows
Improves patient throughput and reduces time to treatment so more
patients treated promptly
Clinics are already adapting and redefining what’s possible
Patient stories using Leksell Gamma Knife
Dr. Theodor Vesaga, Philippine Gamma Knife Center, shares two
compelling patient stories highlighting the impact of precise
radiosurgery for brain metastases.
Improving brain tumor care with advanced imaging
Drs. Chia-Lin (Eric) Tseng and Angus Lau from Sunnybrook show how
using diffusion-weighted imaging (DWI) in adaptive radiotherapy
enhances tumor visibility and supports more precise, personalized
treatment.
Volume adaptive SRS at Kauno Klinikos
Using volume adaptive SRS and staged treatment workflows at Kauno
Klinikos, Lithuania, they have created more options for patients,
particularly those with very large metastasis or when open surgery is
too complicated or risky.
CEST MRI for early brain tumor response to radiotherapy
Researchers at Sunnybrook are using CEST MRI to detect brain tumor
response to radiotherapy earlier than ever before, revealing metabolic
changes mid-treatment that could guide daily adaptation.
The UNITED trial demonstrates that MR-guided adaptive radiotherapy
significantly reduces dose to healthy brain tissue in high-grade
glioma patients, lowering edge recurrence from ~11% to ~4% while
maintaining tumor control.
Dr. Neda Haghighi, Dr. Clare Phillips and A/Prof Gerry Hanna (L to R)
SRS at Peter MacCallum Cancer Centre
By adding Gamma Knife Icon, Peter Mac shifted most complex brain SRS
cases from linac to a dedicated platform, boosting access, precision,
and outcomes for patients with multiple mets.
Treating brain tumors and other lesions is always complex and we're here
to support you. We don't just enable advanced adaptive radiotherapy and
stereotactic radiosurgery, Elekta enables sub-millimetre precision and
daily adaptation to anatomical change. Beyond technology, we partner with
clinicians worldwide to help preserve cognitive and neurological function
while delivering the precision every patient deserves.
The brain demands extraordinary precision
Tumors in the brain like glioblastoma, brain metastases, meningiomas
or acoustic neuromas, can change from session to session. Even subtle
changes in anatomy can affect how much healthy brain tissue is
included within the treated area.
As the whole brain is a critical structure it is crucial to keep dose
outside the target to a minimum, protecting cognitive motor and
sensory movement, you can’t afford to compromise.
Adaptive radiosurgery helps you stay on target. With pre-treatment
imaging and dose reoptimization, you can adapt to what’s changed,
reduce, or even eliminate margins, and deliver treatment with
confidence.6
Adaptation gives you more options, more control
Daily adaptive workflows empower your team to respond to what’s
changing, whether that’s tumor shrinkage, edema reduction, or
anatomical shifts. With clear MR or CBCT images and on-the-fly plan
adaptation, you can:
Reduce or eliminate margins
Confidently reduce margins to protect healthy brain tissue, preserving
motor, sensory and neurocognitive function.7, 8
Adapt to changing anatomy
Adjust plans to match what you see, helping maintain full target
coverage, and reduce dose to organs at risk, as the tumor responds to
treatment.9
Simplify workflow
Make plan adjustments faster and more precisely, without the delays
and resource burden of offline replanning.
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Delivering the future of brain tumor treatment
Whether you’re treating glioblastoma, brain metastases, meningiomas,
acoustic neuromas, or other benign tumors in adult or pediatric cases,
your patient deserves the most accurate treatment possible to ensure
long-term quality of life.
With MR and CT options for daily image guidance, and streamlined workflow
tools to create efficiency, you can deliver more personalized, precise
treatment for your patient, while maintaining high patient throughput and
protecting what matters most.
Explore our adaptive solutions for brain tumors
Our image-guided adaptive solutions help clinicians treat with
sub-millimeter precision, safeguarding healthy brain tissue and critical
structures while maintaining tumor control.
Detsky J et al (2024) MR-Linac On-Line weekly adaptive radiotherapy
for high grade glioma (HGG): results from the UNITED single arm phase
II trial. Int J Radiat Oncol Biol Phys 120(2):S4
2025 Global Impact Report: Precision targeting, global impact – cancer
radiotherapy in the 21st century. (2025). Available at:
https://aboutadaptive.com (Accessed: 16 October 2025).
Stewart, J. et al. (2021) ‘Quantitating interfraction target dynamics
during concurrent chemoradiation for glioblastoma: a prospective
serial imaging study’, International Journal of Radiation Oncology,
Biology, Physics, 109(3), pp. 736–746. Available at:
https://pubmed.ncbi.nlm.nih.gov/33068687/ (Accessed: 16 October 2025).
Cahill J. et al. (2024) ‘Progress of intracranial metastases during
the interval before stereotactic radiosurgery: a retrospective cohort
analysis’, European Journal of Surgical Oncology, 50(12), 108676.
Available at:
https://doi.org/10.1016/j.ejso.2024.108676 (Accessed: 16 October 2025).
Schimmel W.C.M., Verhaak E., Bakker M. et al. (2021) ‘Group and
individual change in cognitive functioning in patients with one to ten
brain metastases following Gamma Knife radiosurgery’, Clinical
Oncology (Royal College of Radiologists), 33(5), pp. 314–321.
Available at:
https://doi.org/10.1016/j.clon.2021.01.003 (Accessed: 16 October 2025).
Chang E.L., Wefel J.S., Hess K.R. et al. (2009) ‘Neurocognition in
patients with brain metastases treated with radiosurgery or
radiosurgery plus whole-brain irradiation: a randomized controlled
trial’, The Lancet Oncology, 10(11), pp. 1037–1044. Available at:
https://doi.org/10.1016/S1470-2045(09)70263-3 (Accessed: 16 October 2025).
Niranjan, A., Monaco, E., Flickinger, J. et al. (2019) ‘Guidelines for
multiple brain metastases radiosurgery’, Progress in Neurological
Surgery, 34, pp. 100–109. Available at:
https://pubmed.ncbi.nlm.nih.gov/31096242/ (Accessed: 16 October 2025).
Tseng C.L., Chen H., Stewart J., Lau A.Z., Chan R.W., Lawrence L.S.P.,
Myrehaug S., Soliman H., Detsky J., Lim-Fat M.J., Lipsman N., Das S.,
Heyn C., Maralani P.J., Binda S., Perry J., Keller B., Stanisz G.J.,
Ruschin M. and Sahgal A. (2022) ‘High-grade glioma radiation therapy
on a high-field 1.5 Tesla MR-Linac – workflow and initial experience
with daily adapt-to-position (ATP) MR guidance: a first report’,
Frontiers in Oncology, 12, 1060098. Available at:
https://doi.org/10.3389/fonc.2022.1060098 (Accessed: 16 October 2025).