Phase III Trial of Stereotactic Radiosurgery (SRS) versus Hippocampal-Avoidant Whole Brain Radiotherapy (HA-WBRT) for 10 or fewer Brain Metastases from Small Cell Lung Cancer

This study is being done to answer the following question: Will high dose radiation therapy delivered only to the small areas of brain cancer and avoiding the surrounding normal brain tissue, called stereotactic radiosurgery (SRS), decrease side effects related to memory and thinking compared to radiation to the entire brain that avoids the hippocampus (the memory zone of the brain) but treats all of the brain tissue, called whole-brain radiation therapy (WBRT), given along with a drug called memantine? For patients with brain metastases from small-cell lung cancer, the usual treatment is WBRT along with a drug that helps preserve memory and thinking called memantine. The purpose of this study is to test if SRS alone is more effective than the usual treatment, WBRT that avoids the hippocampus with memantine. To decide if it is better than usual treatment, the study doctors will be looking to see if the study approach decreases the change of side effects on memory and thinking. The study procedures could also cause side effects, which the doctors will be watching closely. Memantine is FDA approved for treating dementia and is commonly used off-label (that is, for a purpose for which it is not FDA approved) for patients receiving whole-brain radiation therapy for cancer that has spread to the brain.

Are you Eligible? (Inclusion Criteria)

• Are you 18 years of age or older? Have you been diagnosed with Small Cell Lung Cancer, and have had brain metastases visible on a recent MRI scan? Are you willing to make regularly scheduled visits to the clinic for treatment and evaluation, including completing questionnaires?