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Large Brain Met Surgery — SCE Medical Oncology MCQ

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ModerateLung CancerLarge Brain Met SurgerySCE Medical Oncology

A 60-year-old man with NSCLC has a large (5 cm) solitary brain metastasis with significant surrounding oedema causing mass effect. He has controlled extracranial disease. What is the optimal local treatment?

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Correct answer: C — Surgical resection followed by post-operative cavity SRS — for large (>3-4 cm) symptomatic brain metastases with mass effect, surgery provides immediate decompression that SRS cannot achieve

For large brain metastases (>3-4 cm) with significant mass effect/symptoms, surgical resection is preferred over SRS because: (1) immediate decompression/symptom relief, (2) tissue diagnosis if needed, (3) SRS has decreased local control for larger targets (>3 cm). Post-operative cavity SRS (NCCTG N107C) then provides adjuvant local control while avoiding WBRT neurotoxicity. For inoperable large metastases, fractionated SRS (3-5 fractions) may be considered.

Reference: NICE NG99; ESMO Brain Metastases; NCCTG N107C