Do you wait to treat small asymptomatic brain metastases until they reach a certain size?

I typically treat all lesions on MRI that are found to be concerning for brain metastases. This is after a discussion with our neuroradiologist colleagues. If there is uncertainty that a small lesion may not be a brain metastasis, then I will elect to follow with a surveillance MRI and treat in the ...

At our GK institution, treating these small lesions depends on the clinical scenario.

If all the lesions are small and this is a question of new diagnosis of brain mets, then observation with serial imaging is probably best.

If a patient with prior brain mets and only small lesions found on surveill...

No

There is another consideration that I use, and that is the location of such a small asymptomatic target. Because radiosurgery has a minimum spot size, the conformality ratio for very small lesions is high, meaning we take a divot of normal surrounding tissue that can be significantly larger than the...