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Brain Metastases – Treatment Options — SCE Neurology MCQ

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HardNeuro-oncologyBrain Metastases – Treatment OptionsSCE Neurology

A fit 58-year-old with controlled extracranial renal-cell carcinoma has a single 3.8-cm frontal brain metastasis causing hemiparesis and substantial oedema. Tissue would alter systemic treatment. Which local strategy is favoured by the specific factors in NICE NG99?

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Correct answer: C — Neurosurgical resection through the neuro-oncology MDT

Explanation lettering: C = shown as A · D = shown as B · E = shown as C · A = shown as D · B = shown as E

A sacrifices focal control and tissue and is not automatically preferred for one accessible symptomatic lesion. B is inappropriate with deficit and mass effect. C is not a renal-cell metastasis pathway. D ignores the NICE requirement to individualise surgery versus stereotactic treatment. E is correct: large symptomatic accessible disease with oedema and a need for current pathology favours resection, discussed through the neuro-oncology MDT.

Reference: NICE NG99: brain tumours and brain metastases: https://www.nice.org.uk/guidance/ng99/chapter/recommendations