Metastatic brain tumors: Viewpoint—surgery

Metastatic brain tumors are a serious complication of systemic cancer whose annual incidence of over 100,000 continues to rise. Conventional surgery and stereotactic radiosurgery (SRS) each have benefits in the treatment of brain metastases. The advantages of surgery include immediate resolution of mass effect, procurement of tissue for pathological diagnosis, and avoidance of radiation necrosis. The advantages of SRS include decreased risk of hemorrhage and infection and no risk of tumor seeding. SRS is also less invasive, potentially less costly, and requires shorter hospital stays than standard craniotomy. The disadvantages of SRS include potential exacerbation of peritumoral edema, a requirement for long-term steroid administration, and possible radiation necrosis. At The University of Texas M.D. Anderson Cancer Center, surgical resection plays a central role in the management of metastatic brain tumors. SRS is largely reserved for patients who are not candidates for surgery. We believe that a complementary approach employing surgery, whole-brain radiation therapy, and SRS in patients with brain metastasis is best and will continue to evolve.