What are your top takeaways in Neuro Oncology from ASCO 2025?

1. Aizer et al., JCO 2025 - A multi-instituitional Brigham Dana-Farber-led trial randomized 196 patients with 5-20 brain metastases to stereotactic radiosurgery (SRS) or hippocampal avoidance whole brain radiotherapy (HA-WBRT). Patients treated on the SRS arm had significantly less symptom burden, with better performance status, functional independence, and cognitive function over time compared to HA-WBRT. There was no difference in overall survival. This trial establishes SRS as a standard of care for patients with 5-20 brain metastases.
   
   
2. Surendran et al., JCO 2025 - A double blind RCT led by Amrita Institute randomized 130 patients treated with radiation (either SRS or HA-WBRT) to either memantine or placebo. Patients on the memantine arm ha...

The study from Boston on radiosurgery versus whole brain for up to 20 brain mets is quite a discussion in my department. My understanding is that radiosurgery for multiple brain mets up to 20 appears to have favorable neurocognitive preservation rather than whole brain.