Rusthoven CG, Yamamoto M, Bernhardt D, et al. - In patients with small cell lung cancer brain metastases, researchers described as well as compared first-line stereotactic radiosurgery (SRS) results (without previous whole-brain radiotherapy [WBRT] or preventive cranial irradiation) vs those of first-line WBRT via this multicenter cohort study, FIRE-SCLC (First-line Radiosurgery for Small-Cell Lung Cancer). This analysis involved 710 patients (median age, 68.5 years; 531 men [74.8%]) who were treated with SRS between 1994 and 2018. WBRT correlated with enhanced time to central nervous system progression (TTCP), with no improvement in overall survival or central nervous system progression-free survival on propensity score–matched analyses comparing SRS vs WBRT. Multivariable analyses, including subset analyses controlling for extracranial metastases and extracranial disease control status, that compared SRS and WBRT showed similar results. The key trade-offs seen with SRS without WBRT, like a quicker TTCP with no decrease in overall survival, were comparable to those noted in settings where SRS was already established.