Inclusion Criteria

INCLUSION CRITERIA:

Patients must:

1. be 21 years of age or older.

2. have a histologically confirmed primary malignancy.

3. be able to undergo an MRI scan of the brain.

4. have one to three intraparenchymal brain metastases as identified on a brain MRI scan
with intravenous contrast.

5. have contrast enhancing tumor(s) that are well circumscribed and less than or equal
to 4.0 cm in any dimension.

6. be appropriate for either procedure as determined by both a neurosurgeon and a
radiation oncologist.

EXCLUSION CRITERIA:

Patients must not:

1. have tumor(s) in the midbrain, pons, or medulla - patients undergoing surgical
resections in these areas are highly likely to develop significant neurological
deficits or death.

2. have tumors within 10 millimeters of the optic apparatus (nerves and chiasm) or the
area postrema - patients undergoing SRS to these areas are at significant risk of
developing permanent blindness or intractable nausea.

3. be poor operative candidates from an anesthetic point of view secondary to other
major medical illnesses - the risk of undergoing general anesthesia outweighs the
potential benefit of undergoing surgical resection of a brain metastasis.

4. have a coagulopathy demonstrated by an abnormal prothrombin time, activated partial
thromboplastin time, or thrombocytopenia (platelet count less that 150,000
platelets/mm3) - the risk of developing uncontrollable intra-operatively bleeding
outweighs the potential benefit of undergoing surgical resection of a brain
metastasis.

5. have radiographic or cerebrospinal fluid specimen evidence of widespread
leptomeningeal metastasis - neither surgery nor SRS is a useful treatment modality
for this condition.

6. significant psychiatric impairments which, in the opinion of the investigators, will
interfere with the proper administration or completion of the protocol - self
explanatory.

7. acute or untreated infections (viral, bacterial or fungal) - patients with active
infections are highly likely to have spread of their infections to the brain as a
result of a craniotomy.

8. be pregnant at the time of the randomized treatment - general anesthesia and surgery
may subject the fetus to unacceptable risks. Also, the NIH does not offer full
obstetrical services in the event that medical care to the mother and/or fetus is
required. Pregnant women presenting with brain metastases will be referred to
facilities offering OB/GYN services.

9. be prisoners or other institutionalized individuals - these individuals are at risk
of being susceptible to undue influences to participate in a research protocol
against their free will.

10. have a diagnosis of germ cell tumor, lymphoma or small cell lung cancer - these
tumors are highly radiosensitive and should therefore be treated with radiation.

11. have any of the following: aneurysm clip, implanted neural stimulator, implanted
cardiac pacemaker or auto defibrillator, cochlear implant, ocular foreign body or
implant [e.g. metal shavings, retinal clips], or insulin pump as these items would be
contra-indications to undergoing an MRI scan.

12. have an allergy to iodine or shellfish or have previously had an allergic reaction to
iodinated-contrast agents as this is a contra-indication to undergoing a contrast
enhanced CT of the brain - a contrast enhanced CT of the brain is required for the
planning of SRS.