How would you approach a patient with limited stage SCLC who progressed immediately after completing chemoradiation with brain metastasis?

For 1-10 brain metastases from SCLC, consider the NRG CC009 clinical trial randomizing between SRS and hippocampal-avoidance WBRT!

I would recommend radiation to the brain if there is no extracranial progression. I would not start second-line systemic therapy for brain-only progression.