Topics:
Radiation Oncology • Thoracic Malignancies
In oligometastatic NSCLC with a solitary brain metastasis and lung primary amenable to SBRT, how would you sequence first-line systemic therapy versus local therapy to the lung after treatment of the CNS metastasis?
Answer from: Radiation Oncologist at Academic Institution
Would generally favor appropriate first-line systemic therapy whether that be immunotherapy +/- chemo vs. targeted therapy and if at least stable disease at the next surveillance imaging (~3 months), go ahead and consolidate with SBRT. I don't think it would be wrong to do SBRT upfront here but the ...
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Answer from: Radiation Oncologist at Community Practice
How big is the brain met? If it's already large and won't be resected, I'd start with SBRT followed by systemic therapy and then lung SBRT if necessary. OTOH, if the brain met was small, I'd start with systemic treatment and repeat an MRI of the brain in a couple of months to assess response vs. gro...
Answer from: Radiation Oncologist at Community Practice
I would treat both upfront at the same time -- 54 Gy/18 Gy to lung and 27 Gy/9 Gy to brain on a M/W/F.