How do you manage new brain metastases in patients on trastuzumab emtansine (TDM-1) who has controlled extracranial disease?  

A case series from Colorado raises concern over significant radiation necrosis with SRS. However, there doesn't seem to be much additional negative literature available. In fact, some whole brain reports seem positive. Is a break necessary prior to radiation? For multiple metastases, would SRS or whole brain be preferred?

Answer from: Radiation Oncologist at Academic Institution