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Brain Metastases — SCE Medical Oncology MCQ

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ModerateLung CancerBrain MetastasesSCE Medical Oncology

A 72-year-old man with a solitary brain metastasis from NSCLC (3.5 cm, right frontal lobe) causing mild symptoms has well-controlled extracranial disease on pembrolizumab + pemetrexed. ECOG PS 1. Good surgical candidate. What is the preferred local treatment for this solitary brain metastasis?

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Correct answer: A — Surgical resection followed by cavity stereotactic radiosurgery

For solitary brain metastases >3 cm causing symptoms in patients with good performance status and controlled systemic disease, surgical resection followed by post-operative cavity SRS provides the best local control while avoiding whole-brain radiotherapy-associated neurocognitive decline. The NCCTG N107C trial showed post-operative SRS was superior to WBRT for cognitive preservation. For lesions ≤3 cm, SRS alone is preferred. WBRT is reserved for multiple metastases not amenable to SRS.

Reference: NICE NG99 Brain tumours; ESMO 2024 Brain Metastases Guidelines; NCCTG N107C Brown et al Lancet Oncol 2017