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In Reply: Dr Patchell and colleagues raise important issues and limitations in the trial by Dr Aoyama and colleagues.¹ It was indeed underpowered to show equivalence between SRS and SRS plus WBRT. It was terminated early because interim analyses indicated that it would not accrue enough patients to detect a significant difference in the primary end point of survival. Despite this limitation, the study confirmed retrospective data suggesting that WBRT can be deferred.^2-4

Although a higher rate of neurological deterioration attributable to brain metastases was reported in the SRS group, it is unknown whether this decline is related to local vs distant failure; certainly, failure due to distant brain disease would favor an approach using WBRT. The increased neurological deterioration did not result in increased neurological death and was only present in a subset of patients in each group. Although no differences in cognitive function were reported between the groups, . . . [Full Text of this Article]

Jeffrey Raizer, MD
jraizer@nmff.org
Feinberg School of Medicine
Northwestern University
Chicago, Ill

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