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May 12, 1999

Postoperative Radiotherapy for Single Brain Metastases

Author Affiliations

Margaret A.WinkerMD, Deputy EditorIndividualAuthorPhil B.FontanarosaMD, Interim CoeditorIndividualAuthor

JAMA. 1999;281(18):1695. doi:10-1001/pubs.JAMA-ISSN-0098-7484-281-18-jac90004

To the Editor: In an astounding assessment of their own negative outcome, Dr Patchell and colleagues1 conclude that routine postoperative radiation therapy is justified for patients following surgical resection of a single brain metastasis. However, in their well-designed, randomized, multicenter trial, Patchell et al convincingly show that there is no survival benefit or prolonged maintenance of functional independence in patients who received postoperative radiation therapy. The authors do show that the type of death can be altered by a course of radiation therapy, ie, those treated with radiotherapy were more likely to die of systemic causes, whereas those in the observation group were more likely to die of recurrent metastatic disease involving the brain.