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NSCLC with symptomatic brain metastases requiring emergency intervention: focal deficit,...

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IDRF-NSCLC-BRAIN-METS-EMERGENCY
TipoSeñal de alerta
Situaciónreviewed 2026-04-27 | pending_clinical_signoff
EnfermedadesDIS-NSCLC
FuentesSRC-ESMO-NSCLC-METASTATIC-2024 SRC-NCCN-NSCLC-2025

Origen de la bandera roja

DefiniciónNSCLC with symptomatic brain metastases requiring emergency intervention: focal deficit, new seizure, raised intracranial pressure, or impending herniation. Asymptomatic / oligometastatic brain disease handled separately
Dirección clínicaAtención
Categoríadisfunción de los órganos
Algoritmo de cambiosALGO-NSCLC-METASTATIC-1L

Lógica de activación

{
  "any_of": [
    {
      "finding": "brain_metastases_symptomatic",
      "value": true
    },
    {
      "finding": "raised_intracranial_pressure",
      "value": true
    },
    {
      "finding": "new_seizure",
      "value": true
    },
    {
      "comparator": ">",
      "finding": "midline_shift_mm",
      "threshold": 5
    }
  ],
  "type": "composite"
}

Notas

Symptomatic brain mets in NSCLC ~20-30% at presentation. Per NCCN-NSCLC: dexamethasone 4-16 mg/day depending on edema; SRS for ≤4 lesions or WBRT for diffuse; surgical resection for large solitary or herniation-risk. Systemic therapy choice influenced by CNS-penetrant drugs (osimertinib for EGFR, alectinib/lorlatinib for ALK, pembrolizumab active in CNS for PD-L1-high). Direction HOLD on systemic therapy start until ICP controlled; priority 14. STUB — requires clinical co-lead signoff.

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