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In ES-SCLC presenting with limited asymptomatic brain metastases and treated upfront with systemic therapy alone (carbo/etop/atezo), how would you approach the brain if MRI shows PR after a few cycles?

SRS? WBRT? Continued systemic therapy with CNS surveillance?
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For a patient with SCLC who presented with limited asymptomatic brain metastases and was treated with systemic therapy alone (carbo/etop/atezo) with PR in the brain after 2 cycles, how would you manage the brain?

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1 Answer
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Radiation Oncology · Dana Farber/Brigham and Women's Cancer Center
Answered on

In our practice, we would typically watch such a patient on systemic therapy. However, we would stress the need for vigilant monitoring and likely administration of RT (SRS ideally) at the carbo/etop/atezo transition to atezo monotherapy, given the poor intracranial efficacy of the maintenance syste...

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