American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the major initial management option for a solitary brain metastasis?

1. Chemotherapy

2. Whole-brain radiation

3. Surgical resection

4. Observation

The correct answer is: Surgical resection

The major initial management option for a solitary brain metastasis is surgical resection. This approach is often favored because it can provide immediate relief of symptoms caused by the tumor by physically removing it from the brain. This is particularly important for metastatic lesions that cause significant mass effect, such as headaches or neurological deficits. Surgical resection not only alleviates these symptoms, but it also allows for definitive diagnosis and histopathological evaluation, which can be critical for determining further treatment strategies. After resection, additional treatments, such as radiation therapy (either stereotactic or whole-brain radiation therapy), may be employed to target any remaining tumor cells, particularly if the primary cancer has a pattern of recurrence or if the metastatic lesion is not entirely excised. In selected cases, observation might be considered in patients who are not surgical candidates or in the very elderly, but for a solitary metastasis, the priority is often on resection to optimize both the patient's quality of life and management of the underlying malignancy.