Surgical management of brain metastases: how aggressive should we be?

Treatment of cancer metastatic to the brain is dictated by both the need to achieve immediate short-term palliation and the desire for durable symptom-free remission. Surgical resection of brain metastases makes available tissue for diagnosis and experimental study, permits prompt relief of neurological signs and symptoms secondary to tumor mass effect, enhances the potential for sustained local tumor control in those patients with solitary disease, and allows greater therapeutic flexibility by obviating the need for cranial radiation in some situations and by expanding patient access to alternative experimental protocols or systemic chemotherapy.