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Objective To summarize the diagnosis and treatment of refractory brain metastases and leptomeningeal metastases from small cell lung cancer (SCLC). Methods and Results An extensive stage SCLC male patient (44⁃year⁃old) with diffuse parenchymal meningeal metastases and large volume brain metastasis was treated with muti⁃disciplinary team (MDT), namely precise helical tomotherapy with concurrent temozolomide chemotherapy, combined with intrathecal chemotherapy and systemic therapy. After intracranial recurrent, intrathecal chemotherapy and radiotherapy were used to release the symptoms. At last, this patient died of extracranial disease and the survival time after the diagnosis of brain metastases was 16 months. Conclusions For treatment of brain or leptomeningeal metastases, comprehensive and individualized treatment are needed, and MDT treatment discussion is highly recommended. DOI：10.3969/j.issn.1672⁃6731.2019.11.011