A Study of Neoadjuvant Stereotactic Radiosurgery for Large Brain Metastases

Participation Requirements

• Sex:

  ALL

• Eligible Ages:

  18 and up

Participation Criteria

Inclusion Criteria:

* Lymphoma, small cell carcinoma, and seminoma are excluded
* A lesion appropriate for resection, not previously treated with SRS. Lesions should be \> 2 cm and \< 4 cm in largest dimension, and require resection ( e.g. due to mass effect or to obtain a tissue diagnosis). Index lesions will be treated with SRS and surgery, as outlined in the treatment section of the protocol.
* Seen by a neurosurgeon or radiation oncologist and judged to be appropriate for participation in this study, including the ability to tolerate NaSRS, e.g., the ability to lie flat in a stereotactic head frame.
* Any unresected lesions or lesions for which there is no planned immediate resection (non index lesions) must measure \< 3.0 cm in maximal extent on the contrasted MRI or CT brain scan obtained ≤ 35 days prior to pre-registration. Unresected lesions will be treated with SRS as outlined in the treatment section of the protocol. .
* ECOG ≤ 2
* MRI confirmed 1-6 lesions, one of which is the index lesion. Each non-index lesion (up to 5) must measure ≤ 3.0 cm in maximal extent on contrasted MRI scan, and not otherwise require resection.

Note: The pre-registration MRI may be obtained ≤ 35 days prior to enrolment.

Exclusion Criteria:

* Treatment plan respecting normal tissue tolerances using dose fractionation specified within the protocol cannot be achieved.
* pregnancy
* Prior cranial radiotherapy targeting the index lesion, or any prior WBRT.
* Inability to complete a MRI with contrast of the head, or a known allergy to gadolinium.
* Cytotoxic Chemotherapy within 7 days prior to SRS (molecularly targeted therapies , including immune-modulatory drugs, can be given within seven days of SRS at the discretion of the treating physician)
* Metastatic germ cell tumor, small cell carcinoma, or lymphoma or any primary brain tumor
* Imaging Findings:

* Widespread definitive leptomeningeal metastasis.
* A brain metastasis that is located ≤ 2 mm of the optic chiasm
* Evidence of midline shift
* Fourth ventricular narrowing, concerning for hydrocephalus