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In Reply: In response to Dr Patchell and colleagues, the conclusion of our study was that SRS alone could be a treatment option, provided that frequent monitoring of brain tumor status is conducted. We did not recommend the omission of WBRT for patients with brain metastases. We do note that if a sample size of 2250 would be required to show that SRS alone is not inferior to WBRT plus SRS in survival, it implies that the difference in the survival, if any exists, must be very small. We also note that the difference in percentage of participants developing neurological deterioration attributed to brain metastases in the WBRT plus SRS group compared with the SRS-alone group was not statistically significant (20% vs 27%, respectively; ² = 0.865; P = .35).

Since the late 1990s, SRS alone has been used worldwide as a standard treatment for patients with solitary or multiple brain metastases without . . . [Full Text of this Article]

Hidefumi Aoyama, MD, PhD
h-aoyama@umin.ac.jp

Hiroki Shirato, MD, PhD
Department of Radiology
Hokkaido University Graduate School of Medicine
Sapporo, Japan

Masao Tago, MD, PhD; Keiichi Nakagawa, MD, PhD
Department of Radiology
University of Tokyo Hospital
Tokyo, Japan

Gen Kobashi, MD, PhD
Department of Global Health and Epidemiology
Division of Preventive Medicine
Hokkaido University Graduate School of Medicine
Sapporo, Japan

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