How would you treat a solitary intracranial oligometastasis from Ewing's sarcoma that has been resected?

While an uncommon occurrence in pediatric sarcomas, as much as 2-3% of pediatric RMS and EWS cases can metastasize to the CNS. The optimal management strategy has not been evaluated systematically in prior trials due to the rarity of the event. It’s worth noting that many patients with oligometastatic EWS can have prolonged survival if their disease is response to systemic therapy (PMID: 10524449).

Insufficient evidence exists to justify SRS vs. WBRT, although extrapolation from the adult literature suggests that patients with limited intracranial disease can have durable progression free intervals following focal approaches with substantially less morbidity (PMID: 28939223). Surgery is typically not enough for metastatic lesions and adju...