A PHASE III TRIAL COMPARING WHOLE BRAIN IRRADIATION WITH VERSUS WITHOUT STEREOTACTIC RADIOSURGERY BOOST FOR PATIENTS WITH ONE TO THREE UNRESECTED BRAIN METASTASES

Inclusion Criteria

DISEASE CHARACTERISTICS: No more than 1 unresected or subtotally resected brain metastasis
lesion from histologically confirmed systemic malignancy Eligible only if surgical
resection refused by patient or resection deemed inappropriate by patient's physician 1
intraparenchymal metastasis clearly defined on contrast enhanced MRI Maximum diameter of
lesion no greater than 4.0 cm No leukemia or lymphoma Extracranial sites of primary
metastatic disease allowed if no clinical or radiographic evidence of progression within 1
month prior to entry No metastasis to brainstem, midbrain, pons, or medulla No
leptomeningeal metastasis by MRI or CSF evaluation No metastasis within 10 mm of optic
nerves and chiasm (area must be excluded from high dose stereotactic radiosurgery boost
field)

PATIENT CHARACTERISTICS: Age: 18 and over Performance status: 70-100% Karnofsky
Hematopoietic: Absolute neutrophil count at least 1,000/mm3 Platelet count at least
50,000/mm3 Hemoglobin at least 8 g/dL Hepatic: Not specified Renal: Not specified Other:
Neurologic status 0-2 No major medical or psychiatric contraindication to protocol entry
Fertile patients must use effective contraception

PRIOR CONCURRENT THERAPY: Biologic therapy: Not specified Chemotherapy: No concurrent
chemotherapy for systemic cancer Endocrine therapy: Concurrent hormonal therapy, including
tamoxifen, allowed Radiotherapy: No prior cranial radiotherapy Surgery: Prior subtotal
resection allowed Other: No other concurrent treatment for brain metastasis until
recurrence