Pathologically (histologically or cytologically) proven diagnosis of one of the following

solid tumor malignancies within 5 years prior to registration

• non-small cell lung cancer
• melanoma
• breast cancer
• renal cell carcinoma
• gastrointestinal cancer

Definition of Disease

• Patients must have at least 1 and up to 8 total intact brain metastases detected on a

contrast-enhanced MRI (see Appendix I for imaging guidelines) performed ≤ 21

days prior to registration.

• At least 1 of the up to 8 lesions must be a study eligible lesion, defined as lesion

with a maximum diameter as measured on any orthogonal plane (axial, sagittal,

coronal) of equal or >1.0 cm and equal or < 3.0 cm.

• All brain metastases must be located outside of the brainstem and ≥5 mm from the

optic nerves or optic chiasm and ≤ 3.0 cm in maximum dimension.

Note: brainstem metastases per the MRI within 21 days of registration are

an exclusion criterion; however, if the MRI used for treatment planning

performed within 7 days of SRS/FSRS reveals a brainstem metastasis, the

patient remains eligible if the patient is considered an appropriate

radiosurgery candidate per the local investigator.

• Patients must have a diagnosis-specific graded prognostic assessment ≥1.5 (see

Appendix II).

• No more than 2 lesions planned for resection if clinically indicated
• No known leptomeningeal disease (LMD)

Age equal or >18 years

Karnofsky performance status (KPS) equal or >60

Negative urine or serum pregnancy test (in persons of childbearing potential) within 14

days prior to registration. Childbearing potential is defined as any person who has

experienced menarche and who has not undergone surgical sterilization (hysterectomy or

bilateral oophorectomy) or who is not postmenopausal

No prior radiotherapy to the brain (partial or whole brain irradiation, SRS, FSRS, or

prophylactic cranial irradiation [PCI])

New York Heart Association Functional Classification II or better (NYHA Functional

Classification III/IV are not eligible) (Note: Patients with known history or current

symptoms of cardiac disease, or history of treatment with cardiotoxic agents, should

have a clinical risk assessment of cardiac function using the New York Heart

Association Functional Classification);

• No active infection currently requiring IV antibiotic management;
• No hepatic insufficiency resulting in clinical jaundice and/or coagulation defects;
• No chronic obstructive pulmonary disease exacerbation or other acute respiratory

illness precluding study therapy