In light of Aizer et al. data presented at ASCO 2025, what is your threshold for offering SRS/SRT in patients with multiple brain metastases?

Over the past 4 decades, the treatment of brain metastases has been evolving along with advances in technology, from simple whole brain radiation (WBRT) with opposed lateral fields to IMRT-driven treatment (HA-WBRT); similarly, in the field of SRS/SRT, we have pushed the envelope of what we can achi...

In light of the Aizer et al., ASCO, 2025 data presented at ASCO 2025 and at NRG recently—a multicenter phase 3 randomized trial comparing stereotactic radiation to hippocampal avoidance whole-brain radiation therapy (HA-WBRT) in patients with 5–20 brain metastases—I am increasingly inclined to offer...

The Aizer et al. trial presented at ASCO 2025 found overwhelming evidence favoring SRS (better QOL, cognitive, KPS, local control) compared with HA-WBRT. This trial establishes SRS as a standard of care in patients with 5-20 brain metastases.

In my clinic, I offer SRS for patients if they have good ...

We can predict that the threshold to offer SBRT will increase as the payment for EBRT decreases. APM would cause the opposite outcome. HA-WBRT has modest benefits depending on which study you review. What is the distribution of use of HA-WBRT (rural vs metro, etc.)?