Is there any role for SRS+WBRT for patients with a limited number of small brain metastases?

The recent publication from Dr Brown confirmed the finding from prior studies, that omitting upfront whole brain RT doesn't compromise OS in patients with limited brain metastases. More importantly, this second study had neurocognition as the primary end point, and confirmed better neurocognition preservation when upfront WBRT was omitted. In this study, despite much higher intracranial failure rate in SRS alone group, the neurocognition in the long term survivors still better in SRS alone group. This would argue, in the modern era, intracranial tumor progression can be managed. Tumor progression is not the primary cause for neurocogntion decline. With all the existing data, it is most appropriate to routinely recommended SRS alone for such...