Study of Resection Combined With Stereotactic Radiosurgery for 1 to 3 Brain Metastases

Inclusion Criteria:

- Patients must have a previously histopathologically proven diagnosis of malignancy.

- Patients must be evaluated by Neurosurgery and Radiation Oncology

- Patients must have 1-3 brain metastases seen on MRI or CT imaging. At least one brain
metastases must be considered resectable by craniotomy as determined by the treating
neurosurgeon. Brain lesion resection must be considered standard of care. A not
uncommon situation is for a patient to undergo resection of a solitary metastasis, but
prove to have more lesions on subsequent MRIs (perhaps too small to be seen on a
pre-operative MRI). These patients will be eligible if the total number of lesions is
1-3.

- All lesions must be treatable by SRS as determined by the treating neurosurgeon and
radiation oncologist.

- All lesions must be <4 cm in greatest dimension. For patients with more than 1 brain
metastases, only 1 lesion can exceed 3 cm in greatest dimension.

- In patients treated to the post-op surgical cavity, this cavity must be encompassed by
a CTV of <5 cm.

- Patients must have a Karnofsky performance status ≥60.

- Extracranial disease must not be considered imminently life threatening (<2 month
anticipated survival from extracranial disease).

- Patients must be informed of the investigational nature of this study and must sign
and give written informed consent in accordance with institutional and federal
guidelines.

Exclusion Criteria:

- KPS<60

- life expectancy > 2 months