PRIMARY OBJECTIVE:~I. To determine the safety of pre-operative stereotactic radiosurgery (SRS) followed by surgery for brain metastasis.~SECONDARY OBJECTIVES:~I. To evaluate the immune niche in brain metastasis following SRS in the presence of low or high dose dexamethasone.~II. To evaluate the impact of pre-operative SRS on survival outcomes.~OUTLINE: Patients are assigned to 1 of 2 arms.~ARM A: Patients undergo SRS to the brain metastasis for 1-3 fractions over 1-5 days. Patients also receive low dose dexamethasone orally (PO) or intravenously (IV) for 2-21 days until the day of surgical resection. Patients then undergo surgical resection.~ARM B: Patients undergo SRS to the brain metastasis for 1-3 fractions over 1-5 days. Patients also receive high dose dexamethasone PO or IV for 2-21 days until the day of surgical resection. Patients then undergo surgical resection.~After completion of study intervention, patients are followed up for 120 days, and then every 12 weeks thereafter.
This early phase I trial identifies the side effects of stereotactic radiosurgery before surgery in treating patients with cancer that has spread to the brain (brain metastases). Radiation may stimulate an anti-tumor immune response. Giving stereotactic radiosurgery before surgery may reduce the risk of the cancer coming back after surgery.