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Similar content being viewed by others Facts Radiotherapy is a key treatment approach for brain metastases, with increasing use of precision modalities such as stereotactic radiotherapy While precision radiotherapy has improved outcomes, there remains significant variability in tumor and patient radiation response that cannot be accounted for by lesion type, histology, size, or anatomic features alone Molecular alterations appear to be a major contributor to radiation response, with recent progress in the identification of specific genetic predictors of radiation treatment outcomes Increasing use of genomic profiling in radiotherapy for brain metastases is anticipated, particularly for treatment planning, response monitoring, and selection of targeted therapies Open questions Can genomic profiling of brain metastases be used to optimize radiotherapy treatment planning to reduce serious adverse effects

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