There is a significant body of evidence demonstrating the advantages that Stereotactic Radiosurgery (SRS) offers versus whole brain radiation therapy (WBRT) with various prospective trials comparing the 2 modalities in patients with fewer than 4 brain metastases demonstrating that overall survival (OS) is similar. but with WBRT associated with neurocognitive decline. An article on the “Effects of Surgery With Salvage Stereotactic Radiosurgery Versus Surgery With Whole-Brain Radiation Therapy in Patients With One to Four Brain Metastases (JCOG0504): A Phase III, Noninferiority, Randomized Controlled Trial” has recently been published and adds to this evidence concluding SRS is non-inferior to WBRT and can be established as a standard therapy for patients with four or fewer BMs with same median overall survival but with SRS resulting in less patients experiencing grade 2 to 4 cognitive dysfunction.

We are currently undertaking research on quality of life and overall survival of patients with 4 or more brain metastases and together with the multiple phase III trials of SRS vs WBRT, both currently open or under development by others, are helping to answer the question of SRS appropriateness for these patients.