Solitary brain metastases. Radiation, resection, or radiosurgery?

Three treatment options are available for management of the patient with a known thoracic mass and a solitary brain metastasis: external beam radiation, surgical resection, and stereotactic radiosurgery. Traditional external beam radiation may still represent the most appropriate choice in the management of patients with radiosensitive lesions who are in poor health or who have significant risk factors that prohibit other treatment choices. Surgery is recommended in the presence of significant edema, a large intracranial mass, significant symptoms requiring immediate attention, associated hemorrhage, and for superficial lesions. Finally, stereotactic radiosurgery, an important new technique whereby high doses of radiation are targeted directly to the mass, is recommended particularly for deep lesions that are difficult to reach surgically and for treatment of patients for whom surgery is contraindicated. Stereotactic radiosurgery has the added benefits of being noninvasive, effective, and repeatable in the presence of recurrence or other metastatic disease.