CNS Disease   

At the time of initial diagnosis, there was no clear CNS involvement. When it became clinically apparent disease was refractory to EPOCH, there was CS...

Which regimen is preferred in second line for these patients? What is the efficacy of TDXd vs tucatinib in CNS metastases?    

Would you offer consolidative brain SRS, SRS + consolidative RT to the primary (e.g. lung), consolidative RT to the primary alone?

Would the rate of growth, number of nodes involved, size of nodes, ENE etc. affect your decision?   What volume and dose would you recommend?

Aside from symptomatic disease, is there a certain growth cutoff or other criteria that would be a trigger for treatment?