Trial of Preoperative Radiosurgery Versus Postoperative Stereotactic Radiotherapy for Resectable Brain Metastases

This trial is comparing two ways of delivering stereotactic radiosurgery (a very precise, high-dose radiation treatment) for brain metastases that need surgical removal: giving the radiation before surgery (preoperative) versus giving it after surgery (postoperative). Both approaches aim to kill remaining cancer cells, but the timing may affect outcomes like tumor regrowth or radiation side effects. **You may be eligible if...** - You are 18 or older with at least one brain metastasis (secondary brain cancer) up to 4 cm in size that needs surgical removal - You have up to 3 additional smaller brain metastases suitable for direct radiosurgery - Your overall health (Karnofsky score ≥60) and lab values allow surgery - Your life expectancy is estimated at more than 12 months - You have no contraindications to MRI **You may NOT be eligible if...** - Your cancer type is known to be radiosensitive (lymphoma, germ cell tumor, multiple myeloma) - You have more than 4 brain metastases in total - Your tumor is larger than 4 cm - You have signs of dangerous brain swelling requiring urgent surgery - You have cancer spread to the fluid around the brain (leptomeningeal disease) Talk to your doctor to see if this trial is right for you.