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My first dx with brain mets also showed one lesion 1.5cm in size. The pre-treatment MRI with triple contrast showed a second small 6mm lesion. Both of which were treated successfully with focalized radiation ie. Stereotactic similar to Gamma Knife.
Going without Whole Brain Rads (WBR) leaves you open to having more mets show up, as it did for me. However, over the course of the past three years I have had another 14 brain mets treated in batches with an additional 4 focalized treatments. I have so far avoided WBR doing it this way, which has caused me some strong antagonism from my first rad onc.
That said, having WBR upfront does in NO WAY guarentee you to stay brain mets free down the line.
Having a single lesion removed surgically with focalized radiation to area afterwards, as your onc is thinking... (sometimes a few lesions can be removed at one time) is not bad advice, either. This method has a good track record.
Much of what kind of treatment is recommended has to do with your health otherwise, as to any other systemic mets you may have and health in general.
Other than that, the final course of treatment decision is up to you. You can 'fight' for what you prefer, as I did, after doing lots of research and soul searching.
best wishes,
pattyz
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