For patients with brain metastases, do molecular subtypes influence your decision to use SRS versus whole brain radiation?

This is an excellent question and the decision of SRS or WBRT in this setting has significant clinical ramifications. All things being equal, in the situation as described, I would recommend SRS for up to 10 brain metastases in a patient with a good KPS and good systemic therapy options (targeted th...

At this time molecular subtype does not influence my decision for SRS or WBRT. Number of lesions, performance status, and extracranial disease remain key factors in determining radiation modality. There is a push to use targeted therapy based on molecular subtype to delay radiation therapy.