Table 1.

Patients inclusion and exclusion criteria.

Inclusion Criteria

Histologically confirmed malignancy with the presence of one or two intraparenchymal brain metastasis. Age ≥18 years Karnofsky performance status ≥70 Neurologic function status 0–2 Patients may have extracranial sites of metastatic disease Adequate bone marrow reserve (hemoglobin ≥8 grams, absolute neutrophil count ≥1000/mm3, platelets ≥50,000/mm3 Patient must sign a study specific informed consent form. If the patient’s mental status precludes his/her giving informed consent, written informed consent may be given to the patient’s legal representative

Exclusion Criteria

Major medical illness including poor cardiac, pulmonary or renal status which would result in patient being a high risk candidate for neurosurgical procedure Inability to obtain histologic proof of malignancy Leptomeningeal metastases documented by MRI or CSF evaluation Metastases within 10 mm of the optic apparatus so that some portion of the optic nerve or chiasm would be included in the high dose SRS boost field Metastases in the brainstem, midbrain, pons, or medulla Patients with small cell lung cancer, germ-cell tumors, lymphoma, leukemia and multiple myeloma Prior history of radiation therapy Concomitant use of chemotherapy or targeted biological therapy (within a week of SRS treatment) Patients with ≥3 metastases in the brain Allergy to both CT and MRI contrast dyes Platelet count <100,000/mcL or coagulation disorders that cannot be corrected or would render the surgery a high-risk procedure.

Abbreviations: CT: computed tomography, MRI: magnetic resonance imaging.