Management of solitary metastasis to the brain: The role of elective brain irradiation following complete surgical resection

We examined the records of 33 patients who presented with the clinico-radiological diagnosis of solitary brain metastasis and no other evidence of tumor dissemination. Length of survival of patients and patterns of treatment failure were analyzed according to the treatment modalities that were used, i.e., total excision alone or total excision with elective brain irradiation. Both groups were comparable regarding major parameters that affect response and survival in patients with brain metastasis. There did not appear to be any significant advantage to the use of irradiation following excision, at least at the doses employed in this study. We advocate the use of higher doses of irradiation in any curative attempt following total excision of a solitary brain metastasis. A higher incidence of subsequent spinal cord involvement by tumor was found in patients with lesions in the posterior fossa, pointing out the need for careful evaluation of the spinal cord with cerebrospinal fluid cytology and perhaps myelography prior to resection.