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To the Editor: Dr Aoyama and colleagues¹ studied stereotactic radiosurgery (SRS) with and without whole-brain radiation therapy (WBRT) for treatment of brain metastases. We think that the appropriate conclusions from this study are different from those drawn by the authors and by Dr Raizer² in the accompanying Editorial.

In this study, the addition of WBRT to SRS significantly reduced the number of recurrent brain metastases without increasing survival. Omitting WBRT did not produce any difference in neurocognitive functioning. From these data, the authors concluded that WBRT is not necessary and can be safely omitted. However, as noted by the authors, the main reason for omitting WBRT is to avoid the long-term neurotoxic effects. Yet there was no difference between the 2 groups with regard to neurological or neurocognitive functioning, radiation-induced adverse effects, or survival times. Although the rate of deterioration in neurological function was the same in both groups (22/65 . . . [Full Text of this Article]

Roy A. Patchell, MD
rpatchell@aol.com
Division of Neurosurgery
University of Kentucky Medical Center
Lexington

William F. Regine, MD
Department of Radiation Oncology
University of Maryland
Baltimore

Jay S. Loeffler, MD
Department of Radiation Oncology
Massachusetts General Hospital
Boston

Raymond Sawaya, MD
Department of Neurosurgery
University of Texas M. D. Anderson Cancer Center
Houston

David W. Andrews, MD
Department of Neurosurgery
Thomas Jefferson University
Philadelphia, Pa

Lawrence S. Chin, MD
Department of Neurological Surgery
Boston University School of Medicine
Boston, Mass

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