{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T05:02:08Z","timestamp":1784523728704,"version":"3.55.0"},"reference-count":24,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T00:00:00Z","timestamp":1784505600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>The optimal radiotherapy (RT) approach combined with immune checkpoint inhibitors (ICIs) for non-small cell lung cancer (NSCLC) patients with multiple brain metastases (BM) remains controversial. This study compared the clinical efficacy of stereotactic radiotherapy (SRT) plus ICIs versus hippocampal avoidance whole-brain radiotherapy (HA-WBRT) plus ICIs in this population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively reviewed NSCLC patients with multiple BM(&amp;gt;4) who underwent RT plus ICIs from 2018 to 2024. Exclusion criteria included SRT-alone or WBRT-alone, Karnofsky performance status (KPS) &amp;lt;70, suspected leptomeningeal disease, or 1\u20134 BM lesions. Patients were divided into SRT+ICIs and HA-WBRT+ICIs cohorts by 1:1 propensity score matching (PSM). In the matched datasets, overall survival (OS) was the primary endpoint and intracranial progression-free survival (iPFS) was the secondary endpoint. Survival outcomes were analyzed using Kaplan-Meier and log-rank tests. Cox proportional hazards models identified factors associated with OS and iPFS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of the 256 patients diagnosed, 124 eligible patients (992 lesions) were analyzed. After 1:1 PSM, each cohort included 62 patients (SRT+ICIs and HA-WBRT+ICIs). The SRT+ICIs cohort demonstrated significantly longer median OS(21.4 vs. 15.5 months; P&amp;lt;0.001) and median iPFS (10.5 vs. 8.1 months; P&amp;lt;0.001) compared to the HA-WBRT+ICIs cohort. On multivariate analysis, SRT+ICIs was independently associated with improved OS (HR 0.381,95% CI 0.241-0.695, P&amp;lt;0.001) and iPFS (HR 0.513, 95% CI 0.297-0.961,P&amp;lt;0.001) versus HA-WBRT+ICIs. Adverse events (AEs) were similar between cohorts. No grade &amp;gt; 3 AEs were found.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>For NSCLC patients with multiple BM, SRT+ICIs is associated with significantly improved OS and iPFS versus HA-WBRT+ICIs, without an increased risk of AEs. SRT+ICIs represents a promising approach for this population.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fonc.2026.1757781","type":"journal-article","created":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T04:21:07Z","timestamp":1784521267000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Stereotactic versus hippocampal avoidance whole-brain radiotherapy combined with immune checkpoint inhibitors for multiple brain metastases in non-small cell lung cancer: a multi-center retrospective study"],"prefix":"10.3389","volume":"16","author":[{"given":"Xiaoliang","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Radiotherapy, The Third Hospital of Zhangzhou","place":["Zhangzhou, Fujian, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanan","family":"Zheng","sequence":"additional","affiliation":[{"name":"Department of Radiotherapy, The Third Hospital of Zhangzhou","place":["Zhangzhou, Fujian, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aimin","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Oncology, The Third Hospital of Zhangzhou","place":["Zhangzhou, Fujian, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaolan","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Radiotherapy, The Third Hospital of Zhangzhou","place":["Zhangzhou, Fujian, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xudong","family":"Ruan","sequence":"additional","affiliation":[{"name":"Department of Oncology, The Third Hospital of Zhangzhou","place":["Zhangzhou, Fujian, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Choubin","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Oncology, The Third Hospital of Zhangzhou","place":["Zhangzhou, Fujian, 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