Stereotactic Radiosurgery before Resection in Treating Patients with Solid Tumor Brain Metastases

Inclusion Criteria

• Radiographically confirmed solid tumor brain metastases
• Criteria for surgical resection of at least one metastasis per neurosurgeon discretion
• A diagnostic magnetic resonance imaging (MRI) brain or computed tomography (CT) head demonstrating the presence of 1-4 solid tumor brain metastases and lesion to be resected no more than 5 cm in any direction, performed within 30 days prior to stereotactic radiosurgery. If multiple lesions are present, then the total brain metastases volume can be no more than 30 cm^3 excluding the lesion to be resected
• For known primary included in brainmetgpa.com, an estimated median survival no less than 6 months per brainmetgpa.com
• For unknown primary or known primary not included within brainmetgpa.com, an estimated median survival no less than 6 months per principal investigator (PI) discretion * Note: If patient’s estimated median survival is calculated using a histology that is different than the histology demonstrated in final pathology, the patient may remain eligible for all study endpoints per PI discretion
• Surgical candidate per neurosurgeon discretion
• Surgical resection able to be performed within 1 – 4 days after radiosurgery
• Stereotactic radiosurgery candidate per radiation oncologist
• >= 18 years old at the time of informed consent
• Ability to provide written informed consent and Health Insurance Portability and Accountability Act (HIPAA) authorization. This will be assessed by the consenting physician using general questions as outlined in Etchell’s 1999 publication titled Assessment of Patient Capacity to Consent to Treatment. These are general conversation based questions that assess the patient’s ability to understand the medical problem, proposed treatment, alternatives to proposed treatment, and understand the consequences of the medical choices
• Platelet count > 100 k/cumm
• Hemoglobin (Hgb) > 7.5 gm/dL
• International normalized ratio (INR) < 1.3
• Absolute neutrophil count (ANC) > 1.5 k/cumm
• Patients currently on cytotoxic chemotherapy or immunotherapy are eligible, not including anti-VEGF therapy
• If a patient who meets all stated eligibility criteria is enrolled on study and then discovered to be ineligible, the tissue obtained will still be deemed eligible to remain in study for evaluation

Exclusion Criteria

• Women who are pregnant or nursing are not eligible as treatment involves unforeseeable risks to the fetus or child
• Patients who received anti-VEGF therapy within 6 weeks prior to enrollment, as there is increased risk of fatal brain hemorrhage with surgical resection
• Major medical illnesses or psychiatric impairments, which in the investigator’s opinion will prevent administration or completion of the protocol therapy and/or interfere with follow-up
• Patients with more than 4 brain metastases on MRI brain or CT head
• Lesion to be resected is more than 5 cm
• Total volume of metastatic disease more than 30 cm^3 excluding lesion to be resected
• Patients with leptomeningeal metastases documented by MRI or cerebrospinal fluid (CSF) evaluation
• Previous whole brain radiation therapy
• Previous radiation therapy to lesion to be resected
• Planned adjuvant focal therapy including additional radiation therapy to the brain
• Not a surgical candidate per neurosurgeon’s discretion
• Not a radiosurgical candidate per radiation oncologist’s discretion
• Surgery unable to be performed between 1 – 4 days after radiosurgery