Pre-operative Stereotactic Radiosurgery Followed by Resection for Brain Metastases

Inclusion Criteria

• Life expectancy of at least 12 weeks
• Karnofsky performance status of at least 50
• No contraindications to MRI scanning with intravenous contrast.
• MRI scan consistent with brain metastasis as per radiology report.
• Target lesion must measure at least 15 mm in at least one dimension, and no more than 4 cm in any dimension.
• Patients must have an extra-cranial primary tumor diagnosis.
• Patients will have no more than 4 distinct lesions within the brain. At least 1 lesion has been recommended for surgical removal based on size, symptomology, or regional mass effect on the brain.
• Additional lesions will each be treated with stereotactic radiosurgery.
• Patients with a documented symptomatic lesion size smaller than 3cm requiring clinical surgical resection
• Must be aware of the neoplastic nature of his/her disease and willingly provide written, informed consent after being informed of the procedure to be followed, the experimental nature of the therapy, alternatives, potential benefits, side-effects, risks and discomforts

Exclusion Criteria

• Primary tumor histology of lymphoma, leukemia, multiple myeloma or germ cell tumor. Moribund status or status epilepticus.
• Supratentorial mass effect with greater than 5 mm of midline shift or hydrocephalus. Infratentorial mass effect with fourth ventricle effacement or hydrocephalus.
• More than four additional diagnosed brain metastases.
• Contraindication to general anesthesia.
• Adjacent tumor location to optic apparatus or brainstem, precluding achievement of meaningful dose with SRS.
• Primary brain tumor.
• Contraindication to MRI scans or intravenous contrast.
• Pregnant and breast-feeding females.