A Multi-Institutional Analysis

No randomized trial has been published to determine the best choice of initial modern therapy for patients with larger brain metastases: surgical resection, stereotactic radiosurgery (SRS) alone, or a combination of surgery and SRS. We performed a retrospective combined analysis of Levine Cancer Institute and Emory University of SRS alone versus surgery with SRS for patients with larger brain metastases (> 4 cc volume). In this retrospective study, we found that the combination of surgery and SRS led to improved brain local control and overall survival than SRS alone, which remained after adjusting for several prognostic factors.