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For example, radiosurgery can be used to treat multiple metastases and surgically inaccessible locations such as eloquent or deep areas. In addition, resection is often not a safe choice for patients with severe systemic diseases or advanced age as their physical condition may be poor and unsuitable for general anesthesia JQ1 cost [19,20]. However, cystic metastatic tumors themselves are often large and radiosurgery may not be feasible. In this case, the tumors are treated with a decreased radiation dosage to avoid radiation-associated complications [21]. Flickinger [22] reported that tumors with a cystic component greater than 10 mL did not appear to be effectively controlled by radiosurgery alone. Therefore, it is essential to decrease the volume of the cystic components before treating them with radiosurgery. The combination of cyst aspiration and radiosurgery is one possible method [15,23,24,25] that may be more effective and safer than Rapamycin nmr radiosurgery alone. CHARACTERISTICS Large cystic brain metastases share common characteristics with each other. Ebinu et al. [26] analyzed 111 metastatic lesions from 73 patients and reported that lung cancer was the primary cancer in 37 patients (51%) and breast cancer in 7 (10%) patients. Other authors showed similar results with lung cancer reported as the most common origin of brain metastases with breast cancer coming in second [19,27,28]. Cystic change is most common in lung cancer, but also occurs in other metastatic cancers like breast, pancreas, kidney and even melanoma [29]. However, there was a conflicting study that reported breast cancer (50%) as the most common origin and lung cancer (30%) as the second [30]. The distribution of brain metastases varied widely. Some papers did not mention the specific anatomical location of the tumor, but supratentorial lesions are more IRS1 common than infratentorial lesions [19,27]. Ebinu et al. [26] and Yamanaka et al. [30] showed that the frontal lobe (39%) was the most common site of brain metastases, followed by parietal lobe and cerebellum, but Higuchi et al. [28] reported that the parietal lobe (28%) was the most common site. The mean age for detecting cystic brain metastasis is in the fifties and there is no specific evidence to suggest a preposition for either sex [19,21,27,28,30]. Large cystic brain metastases did not appear to be specific to a particular recursive partitioning analysis (RPA) class but most papers reported class I and II as the most common and class III as the least [RPA index: there are three classes in descending prognostic expectancy from 1 to 3; class 1, for patients with Karnofsky performance status (KPS) 70,