Brain Metastases   

Controlled extracranial disease on trastuzumab+pertuzumab for 2 years. Treatment options include Enhertu or WBRT. Not a candidate for SRS or neurosurg...

Would you offer consolidative brain SRS, SRS + consolidative RT to the primary (e.g. lung), consolidative RT to the primary alone?

This has become standard practice at our institution for patients with a good performance status, with whole brain radiotherapy given after the comple...

How often are you scanning the brain and what is your trigger to treat?

CNS recurrence occurred within two years of prior neoadjuvant therapy

The patient is treatment naïve and asymptomatic. She also has disease in the body (bone and liver metastases). 

Patient completed neoadjuvant therapy with TCH 2 years prior, and has no evidence of disease outside the CNS on PET/CT.

Would this be any different for whole brain radiotherapy?

Can SRS or whole brain radiotherapy be reserved for progression in these young, healthy patients?

Do you increase dosage of the TKI or switch to a different generation TKI?  How does your answer differ for EGFR vs. ALK, and for discerete brain...

Some medical oncologists tend to hold anticoagulation in patients who develop brain metastases for fear of causing intracranial hemorrhage.  Is t...

Does the extent/duration of systemic disease control (complete response vs. stable disease, for example) influence your decision?  What about whe...