GLIADEL or Stereotactic Radiosurgery after Surgery for the Treatment of Metastatic Brain Tumor

Inclusion Criteria

• Age 19 years or older (age of consent in Nebraska); Age 18 years or older (for states where the age of majority is 18)
• Performance status: Karnofsky score of >= 60
• Recursive Partitioning Assessment (RPA) class I, II or III with a Karnosfsky performance status (KPS) of >/= 60
• Known or suspected primary solid cancer with metastatic brain tumor(s) – up to four in number and up to 4 cm in size with surgical resection planned for only one
• Adequate platelet count (>= 100,000/mm^3)
• Laboratory values adequate for patient to undergo surgery safely as determined by the attending neurosurgeon (transfusion permitted to reach goals)
• Women of childbearing potential must have a negative pregnancy test within 7 days of initiating study. (No childbearing potential is defined as age 55 years or older and no menses for two years or any age with surgical removal of the uterus and/or both ovaries)
• Normal coagulation studies (International Normalized Ratio [INR] =< 1.3)
• Estimated survival time of >= 3 months as determined by the patient’s primary oncologist
• The subject is willing and able to consent to and abide by the protocol

Exclusion Criteria

• Prior treatment to the area of planned resection (surgery, radiation)
• Prior whole brain radiation therapy
• Diagnosis of lymphoma, germ cell cancer, small cell lung cancer, anaplastic thyroid cancer
• Leptomeningeal disease
• Neurodegenerative disorder (e.g. dementia)
• Tumor size > 4 cm
• KPS < 60
• Inability or unwillingness to co-operate with the requirements of the protocol
• Any other clinically significant medical disease or condition laboratory abnormality or psychiatric illness that, in the investigator’s opinion, may interfere with protocol adherence or confound efficacy or safety assessment or a subject’s ability to give informed consent
• Simultaneous participation in other therapeutic clinical trials will not be allowed
• Severe pulmonary, cardiac or other systemic disease, specifically: * New York Heart Association > grade 2 congestive heart failure within 6 months prior to study entry, unless asymptomatic and well controlled with medication * Uncontrolled or significant cardiovascular disease, clinically significant ventricular arrhythmia (such as ventricular tachycardia, ventricular fibrillation, or Torsades des pointes), clinically significant pulmonary disease (such as >= grade 2 dyspnea, according to Common Terminology Criteria for Adverse Events [CTCAE] 4.03)
• Subjects who have any other disease, either metabolic or psychological, which as per the Investigator assessment may affect the subject’s compliance or place the subject at higher risk of potential treatment complications
• The subject has a bleeding diathesis, or must take anticoagulants, or antiplatelet agents including NSAIDs (non-steroidal anti-inflammatory drugs), at the time of scheduled resection that cannot be stopped for surgery
• Lack of available tissue from primary site is NOT an exclusion criteria for the study
• Inability to obtain magnetic resonance imaging (MRI) studies