Abstract
Questions Should patients with confirmed single brain metastasis undergo surgical resection? Should patients with single brain metastasis undergoing surgical resection receive adjuvant whole-brain radiation therapy (wbrt)? What is the role of stereotactic radiosurgery (srs) in the management of patients with single brain metastasis?
Highlights
QuestionsShould patients with confirmed single brain metastasis undergo surgical resection?Should patients with single brain metastasis undergoing surgical resection receive adjuvant whole brain radiation therapy (WBRT)?2
Evidence comparing SRS with surgical resection or examining SRS with or without WBRT was limited to prospective case series and retrospective studies
All patients randomized to the surgery plus WBRT groups in the trials by Patchell et al 5 and Vecht et al 8 underwent surgical resection, but treatment compliance with WBRT was not reported
Summary
Cerebral metastases occur in 15%–30% of cancer patients during the course of their disease 1–3 Half of these patients have single metastasis as shown by computed tomography (CT) imaging 2–4. Because the distinctions between intracranial primary and metastatic cancer and between single and multiple metastases frequently determine choice of treatment, care must be taken in the initial diagnosis of a suspected metastasis. In individuals that appear to have a single metastasis and in whom the primary tumour site is controlled or unknown, high-dose contrast imaging studies are appropriate. These studies may be accomplished with iodinated contrast and a repeat CT scan. Surgical resection or stereotactic biopsy should be used if a solitary lesion with characteristics of a cancer is seen with no known primary to establish tissue diagnosis before other treatments commence
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