Surgery and Whole Brain Radiotherapy (RT) Versus Whole Brain Radiotherapy (RT) and Radiosurgery for 1-3 Resectable Brain Metastases

Inclusion Criteria:

• Histopathology of primary tumors: all but primary small cell cancer, germ cell tumors, leukemia, lymphoma, or primary central nervous system.
• Primary-site: controlled, meaning operated and / or irradiated; without detectable local tumor activity
• Lack of extra-cranial metastases
• Absence of prior brain irradiation
• Number of brain metastases: 1-3
• Location of brain metastases: brain regions eligible for surgery (non-eloquent areas) and RC (metastases with largest diameter ≤ 3 cm, volume <15 mL, and> 5 mm from the optic chiasm, optic nerves, thalamus, hypothalamus, basal ganglia base, optic tract, optic radiation, midbrain, pons, medulla, corpus callosum, internal capsule, hippocampus and amygdala, and <10 ml of brain tissue receiving ≥ 12 Gy).
• Metastasis-that does not cause significant mass effect and hydrocephalus or herniation requiring urgent surgical intervention
• Second uncontrolled primary tumor site: none, except non-melanoma skin cancer
• Absence of comorbid conditions that prevents surgery for resection of brain metastases
• Absence of connective tissue disease such as lupus erythematosus or scleroderma
• Patients in chemotherapy need to have their chemotherapy treatment suspended.
• Patients must consent to be followed by clinical staff of the Barretos Cancer Hospital (HCB).
• KPS: ≥ 70%
• Neutrophils ≥ 1800 cells / mL until 14 days prior to study entry
• Platelets ≥ 100,000 cells / mL until 14 days prior to study entry
• Hemoglobin ≥ 10 g / dL 14 days prior to entering the study (transfusion is allowed to achieve required concentration)
• Creatinine ≤ 1.7 mg / dL 14 days prior to study entry
• BUN ≤ 30 mg / dL 14 days prior to entry on study
• Bilirubin ≤ 2 mg / dL 14 days prior to study entry
• TGO/TGP Up to three times normal on examination until 14 days prior to study entry Prothrombin time-INR <1.4 at examination until 14 days prior to study entry
• Systolic pressure ≤ 160 mm Hg and diastolic pressure ≤ 90 mm Hg at examination until 14 days prior to study entry Electrocardiogram-without acute myocardial infarction in examination until 14 days prior to study entry
• No active bleeding or pathological condition that entails high risk of bleeding
• Negative pregnancy test at least 14 days prior to study entry
• Informed Consent: The patient will be informed of the investigational nature of treatment and only enter the study after agreeing to participate in the study signed a consent form that informs the side effects and possible benefits and potential of both modalities treatment.

Exclusion Criteria:

• Metastasis in the posterior fossa, because this patient will be operated.