A timely review that radiosurgery improves quality-of-life versus hippocampal-avoidance whole brain radiation plus memantine for patients with 5–20 metastases, extending the radiosurgery paradigm well beyond the traditional synchronous 1–4 targets. Meanwhile, a patient-level meta-analysis suggests neurocognitive decline after brain radiation is not necessarily permanent: 38% of patients meeting trial definitions of cognitive failure subsequently recovered by 6 months, with recovery more common after radiosurgery. CYBER-SPACE further demonstrateD that repeated radiosurgery with close MRI surveillance can defer WBRT in most patients. Meanwhile a prospective phase 2 study suggests radiosurgery in lieu of WBRT may be a reasonable option for selected patients with small cell lung cancer with as many as 10 brain metastases. | Martin, Int J Radiat Oncol Biol Phys 2026
