There has been ongoing debate regarding the value of stereotactic radiosurgery (SRS) alone compared with SRS plus whole brain radiation therapy (WBRT) for patients who have limited metastatic lesions in the brain. In this issue of JAMA, Brown and colleagues report the results of a randomized clinical trial (RCT) in which 213 patients with 1 to 3 brain metastases all less than 3 cm in diameter were randomized to either SRS alone or SRS plus WBRT.1 Compared with SRS plus WBRT, there was less cognitive deterioration at 3 months after SRS alone (63.5% [40/63 patients] vs 91.7% [44/48]; difference, 28.2%; 90% CI, 14.%-41.9%) and better quality of life (mean change from baseline, −0.1 vs −12.0 points; mean difference, −11.9 points; 95% CI, −19 to −14.8 points). In contrast, intracranial disease control rates (local and distant) at 3 months were 93.7% (89/95) with SRS plus WBRT and 75.3% (79/105) with SRS alone, a mean difference of 18.4% (95% CI, 7.8%-29.0%). Median overall survival was similar in the 2 groups (SRS alone, 10.4 months; SRS plus WBRT, 7.4 months; hazard ratio, 1.02; 95% CI, 0.75-1.38).
Kaidar-Person O, Anders CK, Zagar TM. Whole Brain Radiotherapy for Brain Metastases: Is the Debate Over? JAMA. 2016;316(4):393–395. doi:10.1001/jama.2016.8692
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