Surgery, Stereotactic Radiosurgery, and Systemic Therapy in the Management of Operable Brain Metastasis

Brain metastasis represents the most common intracranial tumor. Surgery has a key role in patients with an unknown primary, solitary site, large intracranial lesion, or those with neurologic symptomatology due to associated vasogenic edema and mass effect. There is also a resurgence in interest in biopsy or resection in patients with actionable alterations with discordant responses to targeted therapy or those proceeding to immunotherapy to reduce corticosteroid requirements. Moreover, advancements in radiotherapy have led to several options in patients with resectable brain metastasis including postoperative whole-brain radiotherapy, postoperative stereotactic radiosurgery (SRS), preoperative SRS, intraoperative radiotherapy, and CNS brachytherapy.