What is the management of locally recurrent brain metastases that has undergone multiple resections and previous cavity SRS?  

For local recurrence after prior SRS that we're convinced does not represent treatment effect, I consult with my neurosurgery colleagues regarding further surgical options including laser interstitial thermal therapy (which is typically preceded by biopsy). If surgical options don't exist, I general...

This is a challenging but all too frequent scenario. In conjunction with our colleagues in neurosurgery, we have begun utilizing the GammaTile device for these situations. This device, utilizing Cs-131 seeds embedded in an implantable collagen matrix, is utilized to line the post (re-) resection cav...

In these scenarios, a multidisciplinary review is critical. All such cases at our institution are reviewed at our CNS tumor board with an additional neurosurgeon, neuroradiologist, and neurooncologist feedback. Typically, the first step is using all available imaging modalities to exclude radio...

Thanks, @Evan Thomas, for the shout-out.  The variety of answers underlie the obvious fact that there is no one standard option to diagnose or manage progression after radiosurgery. A variety of reasonable options have already been proposed. I can only add a biased opinion. I have taken a ...