Clinical Trial Finder

Inclusion Criteria:

• - Have a prior histologic diagnosis of cancer other than small cell lung cancer, lymphoma, and germ cell histologies.

• - Magnetic resonance imaging (MRI) evidence of 1-4 brain metastases, with at least one lesion > 20 mm and ≤ 50 mm in maximal diameter and determined to be appropriate for SRS and gross total resection; all other brain metastases are appropriate for SRS.

• - Patient can have prior SRS to lesions other than the one planned for neoadjuvant SRS and resection.

• - Patient must have a Karnofsky performance score of ≥ 70.

Exclusion Criteria:

• - Patient deemed medically unfit to undergo surgical resection of brain metastasis.

• - Prior whole brain radiotherapy.

• - Patient with contraindication for imaging with MRI.

• - Inability to participate in study activities due to physical or mental limitations.

• - Inability or unwillingness to return for all the required follow-up visits.

• - At the time of planning, unable to deliver 10 Gray (Gy) or less to optic nerve/chiasm.

• - Tumor located in the brainstem.

- Imaging or cytologic evidence of leptomeningeal disease

PRIMARY OBJECTIVES:

• I. To determine the safety (risk of acute and long-term toxicities) of neoadjuvant radiosurgery at escalating doses followed by surgical resection of brain metastases.

(Phase I)

• II. To determine the local control of brain metastases treated with neoadjuvant radiosurgery followed by surgical resection.

(Phase II) SECONDARY OBJECTIVES:

• I. To determine the rate of distant brain failure when brain metastases are managed with neoadjuvant radiosurgery followed by surgical resection.

• II. To estimate the rate of salvage surgery, whole brain radiation therapy (WBRT), or stereotactic radiosurgery (SRS) for participants treated with neoadjuvant radiosurgery followed by surgical resection.

• III. To determine the rate of radiation necrosis/steroid dependency.

• IV. To determine the radiobiologic impact of neoadjuvant radiosurgery for resected brain metastases.

OUTLINE: This is a phase I, dose-escalation study of radiosurgery followed by a phase II study. The following outcomes were removed from the protocol in an amendment:

• - Changes in neurocognitive function as measured by the Hopkins Verbal Learning Test (HVLT), Controlled Oral Word Association (COWA) & Trailmaking Test B, and Trailmaking Test A.

- QOL measured by FACT-BR and EORTC-QLQ30

Arms

Experimental: Treatment (radiosurgery, surgery)

Patients undergo radiosurgery on day 0. Within 2 weeks, patients undergo surgical resection.

Interventions

Radiation: - radiosurgery

Undergo radiosurgery

Procedure: - therapeutic conventional surgery

Undergo surgical resection

Procedure: - quality-of-life assessment

Ancillary studies