Table 1.

Selection criteria

Inclusion criteria	Non-inclusion criteria
≤ 4 distinct brain metastases, one with surgical indication	Lymphoma, leukaemia, multiple myeloma, germinal tumours or cerebral primary cancer
Diagnosis of histologically proven breast, digestive, non-small cells lung cancer, kidney or melanoma	Metastases from small-cells lung cancer or sarcoma
≤ 5 cm larger diameter	Mass effect with deflection ≥5 mm from median line or hydrocephaly or compression 4th ventricle, patient neurologically unstable, need for emergency decompressive surgery
Karnofsky performance status ≥70	>  4 brain metastases
No contraindication for MRI	Contraindication to anaesthesia, MRI or gadolinium injection
Possibility for the patient to be treat with both surgery and stereotactic radiotherapy	Proximity of the tumour with organs at risk which do not allow the prescribed dose to be reached in the envelope
≥ 18 years old	Pregnant or breastfeeding woman
Estimated overall survival ≥6 months according to DS GPA	Anti VEGF within 6 weeks before treatment
Written inform consent signed	Documented leptomeningeal injury
Affiliation to the French social security system	History of irradiation of the encephalon in toto
For women of childbearing age including those on LH-RH agonists for ovarian suppression: inclusion negative serum pregnancy test (≤ 7 days prior to the start of preoperative RSH).	History of stereotactic radiotherapy on metastasis to be operated on
	Non-candidate patient for surgery
	Surgical delay > 3 days compared to stereotactic radiotherapy
	Estimated survival < 6 months by DS GPA
	Patient under guardianship or curatorship
	Psychological disorder (cognitive disorders, mental alertness, etc.) or social (deprivation of liberty by judicial or administrative decision) or geographical reasons that may compromise medical monitoring of the trial or compliance with treatment
	Woman of childbearing age without effective contraception
	Patient participating in another intervention study within 4 weeks prior to inclusion