Letters Section Editor: Robert M. Golub, MD, Senior Editor.
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
Raizer J. Radiosurgery Plus Whole-Brain Radiation Therapy for Brain Metastases—Reply. JAMA. 2006;296(17):2089-2091. doi:10.1001/jama.296.17.2090-b