Review Question - QID 106285

Surgical resection of the mass is the appropriate course of action for a single brain metastasis, making answer 5 correct.

In this scenario, brain metastasis is a concern given the patient's recent breast cancer diagnosis, unexplainable worsening headaches, and CT evidence of a brain mass at the gray-white matter junction. For patients with a single brain metastasis and stable extra-cranial disease, surgical resection followed by irradiation to the whole brain is the standard of practice.

As Balducci and Phillips note, surgery is often employed initially in cases of suspected single brain metastasis for both confirmation of diagnosis and therapy. It offers the best opportunity for local control. They authors also discuss factors that increase the risk of metastasis, which can aid in the development of a treatment plan (see illustration A).

As outlined in the National Comprehensive Cancer Network (NCCN) guidelines, there are a few instances where stereotactic radiosurgery should be used in place of standard surgery for single brain metastasis. Specifically, this should be considered if the metastasis is less than 3cm in size, is in a surgically inaccessible/undesirable location, or if the patient is a poor candidate for traditional surgery.

Illustration A is a table listing the factors that increase the risk of cancer metastasis.

Incorrect Answers:
Answer 1: Chemotherapy may be part of the eventual treatment plan for this patient's metastasis, but it is not the first step in treatment.
Answer 2: Given this patient's good performance status and age, surgical resection should be attempted first.
Answer 3: Although the breasts were the original source of the cancer, the cancer is now in the brain, which requires treatment.
Answer 4: If there were multiple brain metastasis, then irradiation would be the first line of action.