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The main point of Dr Mira's letter is that patients with small cell carcinoma of the lung have a greater tendency to have brain metastases develop with increasing length of survival. We agree with this statement and expressed this in our article. Our article states that the present aggressive regimens may result in an improved survival and, therefore, an increase in the incidence of brain metastases. This hypothesis was based on our finding that those patients who lived longer had an increased incidence of brain metastases. We then quoted Hansen who had similar findings and conclusions. Perhaps instead of stating that "patients who developed brain metastases had a longer survival," any misinterpretation could have been prevented if we had simply stated that those patients who survived longer had a greater tendency to have the development of brain metastases.We do agree with the comments by Dr Mira on
Burgess RE, DiBella NJ. Length of Survival With Brain Metastases-Reply. JAMA. 1981;245(7):704–705. doi:10.1001/jama.1981.03310320028014
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