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

Deterministic view of the source YAML entity. Clinical authority remains with the cited source IDs and reviewer sign-off state.

ID	`RF-SCLC-BRAIN-METS-EMERGENCY`
Type	Red flag
Status	reviewed 2026-04-27 \| pending_clinical_signoff
Diseases	`DIS-SCLC`
Sources	`SRC-ESMO-SCLC-2021` `SRC-NCCN-SCLC-2025`

Red Flag Origin

Definition	SCLC with symptomatic brain metastases requiring emergency intervention: focal deficit, new seizure, raised intracranial pressure. SCLC has high CNS-tropism — brain metastases at presentation in ~10-15%, ~50-80% by death without prophylactic cranial irradiation
Clinical direction	hold
Category	organ-dysfunction
Shifts algorithm	ALGO-SCLC-1L

Trigger Logic

{
  "any_of": [
    {
      "finding": "brain_metastases_symptomatic",
      "value": true
    },
    {
      "finding": "raised_intracranial_pressure",
      "value": true
    },
    {
      "finding": "new_seizure",
      "value": true
    }
  ],
  "type": "composite"
}

Notes

Per NCCN-SCLC + ESMO-SCLC 2021: WBRT (30 Gy/10 fx) is preferred for symptomatic SCLC brain mets given multifocality; SRS for limited disease in select cases; dexamethasone 4-16 mg/day for edema. Concurrent platinum-etoposide chemotherapy active in CNS — can start simultaneously. Direction HOLD on routine systemic start until ICP controlled. Priority 14. STUB — requires clinical co-lead signoff.

Used By

Indications

IND-SCLC-RR-LURBINECTEDIN - IND-SCLC-RR-LURBINECTEDIN
IND-SCLC-RR-TARLATAMAB - IND-SCLC-RR-TARLATAMAB
IND-SCLC-RR-TOPOTECAN - IND-SCLC-RR-TOPOTECAN