Phase II Single-arm Study of Pre-operative Stereotactic Radiosurgery for Brain Metastases.

• DISEASE CHARACTERISTICS:

• Diagnosis of brain metastases from an extracranial primary site

• Tumor ≤ 4 cm in maximal extent in any plane on contrast MRI

• Scheduled to undergo gross total resection of a single brain metastasis confirmed by histology

• Up to 4 metastases allowed provided the largest mass is amenable to surgical resection and all non-resected masses are amenable to stereotactic radiosurgery (SRS)

• RTOG Recursive Partitioning Analysis (RPA) class 1 or 2, as defined by the following:

• RPA class 1: Karnofsky performance status (KPS) 70-100%; age < 65 years; controlled primary disease; and no extracranial metastatic disease

• RPA class 2: KPS 70-100%; uncontrolled primary disease; and/or extracranial metastatic disease

• No lesion located in anatomic regions that are not amenable to SRS, including the brain stem, optic apparatus, or eloquent cortex

• No primary lesion with radiosensitive histology (e.g., small cell carcinoma, germ cell tumors, lymphoma, leukemia, or multiple myeloma)

• No radiographic or cytologic evidence of leptomeningeal disease

• PATIENT CHARACTERISTICS:

• See Disease Characteristics

• Not pregnant or nursing

• Negative pregnancy test

• No concurrent uncontrolled illness including, but not limited to, any of the following:

• Symptomatic congestive heart failure

• Unstable angina pectoris

• Psychiatric illness

• No contraindication to SRS, whole-brain radiotherapy, or MRI

• PRIOR CONCURRENT THERAPY:

• See Disease Characteristics

• No prior brain surgery other than resection of metastasis

• No prior brain radiotherapy