Yomo and Hayashi reported results of stereotactic radiosurgery alone for brain metastases from small cell lung cancer. This strategy aims to avoid the neurocognitive effects of whole-brain radiation therapy. However, radiosurgery alone increases the risk of distant intracranial relapse, which can independently worsen cognition. This concern is heightened in histologies like small cell with high predilection for intracranial spread. The majority of study patients developed new brain disease, suggesting radiosurgery alone may not be an optimal strategy for preserving neurocognitive function in this population. We suggest whole-brain radiation therapy should remain the standard of care for small cell lung cancer.