Do you offer systemic therapy for NSCLC (no driver mutation) after resection of a metachronous solitary brain metastasis occuring after definitive therapy for limited disease, with no evidence of active extracranial disease?  

I'm not sure that I have any definitive evidence to present regarding this (ie no trial data), speaking primarily from experience and bias. As I take it, the patient presented in the question is now surgically NED and has had appropriate treatment of his isolated metastatic site of disease with no k...

I agree with @Gregory A. Otterson's rationale and logic. This patient's greatest risk is for over-treatment (Dr. Otterson's #1 rationale above) and, in the setting of definite metastatic disease, I cannot rationalize exposing the patient to risk for, at best, uncertain benefit. Many patients, of cou...