Letters Section Editor: Robert M. Golub, MD, Senior Editor.
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; χ2 = 0.865; P = .35).
Aoyama H, Shirato H, Tago M, Nakagawa K, Kobashi G. Radiosurgery Plus Whole-Brain Radiation Therapy for Brain Metastases—Reply. JAMA. 2006;296(17):2089-2091. doi:10.1001/jama.296.17.2090-a