The Role of Radiation Therapy in the Management of Metastatic Melanoma in the Brain

Table 1

Relative advantage of surgery and stereotactic radiosurgery for single or oligobrain metastases.

	Surgery	Stereotactic radiosurgery
Indications	(i) When histological confirmation is needed.; (ii) Single or “dominant” lesion.; (iii) Prominent cystic component or necrosis.; (iv) Prior radiosurgery treatment failure.	(i) Lesion in eloquent locations.; (ii) Oligometastatic disease.; (iii) When lesions are associated with mild or no clinical symptoms.; (iv) Contraindications to craniotomy (e.g., high anesthesia risk and anticoagulation).
Advantages	(i) Prompt symptom relief e.g., from obstructive hydrocephalus, mass effect; midline shift, intratumoral, or intracerebral bleed.; (ii) No size limit.	(i) Outpatient day only procedure.; (ii) Concurrent chemotherapy or imminent treatment protocol, especially antiangiogenesis therapy.
Disadvantages	(i) Depends on expertise of surgeon.; (ii) Lesion needs to be surgically accessible.	(i) Depends on expertise of radiosurgery team.; (ii) Lesion needs to be favourable that is, size <3 cm, solid tumor, with homogenous enhancement and minimal vasogenic edema, no hydrocephalus.