A randomized Phase 3 trial reported that stereotactic radiosurgery nearly doubled median survival in patients with small cell lung cancer and brain metastases, compared with hippocampal-avoidant whole-brain radiation therapy. The study reported a median overall survival of 17.4 months versus 8.6 months, and did not show significant differences in cognitive decline or serious side effects. The results reinforce radiosurgery’s role for select intracranial disease and may influence how radiation oncology teams sequence treatment to balance survival benefit against neurocognitive risk. With small cell lung cancer’s aggressive course, the survival gain is likely to drive guideline and practice discussion.