Confronting ethical challenges and guideline deviations in neuro-oncological radiosurgery

Stereotactic radiosurgery (SRS) has transformed neuro-oncological 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.