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Radiation Oncology • Stereotactic Radiosurgery
In what situations will you defer SRS for newly detected brain metastases in a patient with an oncogene driven malignancy?
For instance, in a patient with Her2(+) breast cancer and 3x small newly diagnosed asymptomatic brain metastases, would you consider a trial of TDM-1 therapy before SRS?
Answer from: Radiation Oncologist at Community Practice
We have deferred RT only in situation where there is open clinical trial (we had one with oral Her2 new agent for asymptomatic brain metastases and there are other ongoing studies). Outside of a clinical trial, we offer RT upfront rather than waiting for response from systemic agent.
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Answer from: Radiation Oncologist at Academic Institution
I would and do consider holding off on SRS if a patient has a small asymptomatic lesion without significant edema. I would recommend very close active surveillance.