Highlights from the 2025 ASCO annual meeting: central nervous system

Stereotactic radiation versus hippocampal avoidance whole brain radiation in patients with 5-20 brain metastases: A multicenter, phase 3 randomized trialPrior trials have demonstrated that stereotactic radiosurgery (SRS)/stereotactic radiotherapy (SRT) yields better outcomes than traditional whole brain radiotherapy (WBRT) in patients with 1-4 brain metastases, and that hippocampal avoidance WBRT (HA-WBRT) is superior to traditional WBRT.Despite that, trials for more than 4 brain metastases are lacking, and there are no head-to-head comparisons between stereotactic radiation and HA-WBRT.In a clinical science symposium, Dr Ayal Aizer presented the results of a multicenter, phase 3 trial that compared stereotactic radiation versus HA-WBRT in patients with 5-20 brain metastases.The primary endpoint was symptom severity and interference in daily activities, which was accessed by an MD Anderson symptom inventory brain tumor questionnaire, at baseline and after 6 months.Other outcomes were performance status, ability to complete activities of daily living, neurocognitive function, recurrence, and salvage therapy, among others.Between april 2017 and may 2024, 196 patients were enrolled, with a median number of brain metastases of 14, mainly from non-small cell lung cancer (47%) or breast cancer (20%).This study demonstrated that SRS/SRT reduces symptom severity and interference with daily function compared to HA-WBRT, without compromising survival.Patients experienced less symptoms such as pain, nausea,